Revivecare Medical & Wellness LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVIVECARE MEDICAL & WELLNESS LLC

Practice address

2925 E South St
Orlando, FL 32803-6459

Phone

(321) 209-2203

Fax

(888) 344-9692

NPI assigned

Dec 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tima Doron, ARNP

Title

Arnp

Phone

(407) 300-8768

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1659147486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 BIRCHWOOD AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444015",
            "telephone_number": "407-300-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 E SOUTH ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328036459",
            "telephone_number": "321-209-2203",
            "fax_number": "888-344-9692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVECARE MEDICAL & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-11-25",
        "status": "A",
        "authorized_official_last_name": "DORON",
        "authorized_official_first_name": "TIMA",
        "authorized_official_title_or_position": "ARNP",
        "authorized_official_telephone_number": "407-300-8768",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Orlando, FL
• Providers in Orlando, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.