NPIMap

Organization Active NPI

Revivecare Medical & Wellness LLC

  • Clinic/Center
  • Orlando, FL
National Provider Identifier
1659147486
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
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
Last updated
Dec 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Tima Doron, ARNPNPI 1881055473
Title
Arnp
Phone
(407) 300-8768

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2925 E South St
Orlando, FL 32803-6459

Mailing address

1534 Birchwood Ave
Kissimmee, FL 34744-4015
Phone (407) 300-8768

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in Orlando, FL

Sources for this page

  • 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.