Ageless Dynamics LLC Hydrate and Renew IV Solutions
Organization Active NPI Acute Care Nurse Practitioner · Estero, FL
NPI 1467249219 · NPPES record last updated Apr 24, 2025
Key facts
- NPI
- 1467249219
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- Legal business name
- AGELESS DYNAMICS LLC HYDRATE AND RENEW IV SOLUTIONS
- Practice address
- 19757 The Place Blvd
Estero, FL 33928-6608 - Phone
- (425) 971-0990
- NPI assigned
- Apr 24, 2025
- Organization subpart
- No
Authorized official
- Name
- Lori Khristine Axford
- Title
- Owner / Practitioner
- Phone
- (425) 971-0990
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250511000014 | FL | Part B Supplier - Clinic/Group Practice | 9335666593 |
Receives reassigned benefits from 1 practitioner Practice locations: Estero, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner |
363LA2100X | Yes |
Addresses
Primary practice location
19757 The Place Blvd
Estero, FL 33928-6608
Mailing address
19757 The Place Blvd
Estero, FL 33928-6608
Phone (425) 971-0990
Other names
- Ageless Dynamics LLC
Other providers in Estero, FL
- Meagan Stark Abel
- Francis Acheampong
- Victoria Leigh Ade Harvey
- David Adkins
- Affordable Dentures & Implants - Estero II, P.a.
- Ana Lucia Aguilar Munoz
- Tasnova Ahmad
- Barbara Ann Ahmann
- Sara Al Nooh
- Albertsons LLC
All providers in Estero, FL · Acute Care Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.