Provider Demographics
NPI:1073219523
Name:REJUVENE LLC
Entity Type:Organization
Organization Name:REJUVENE LLC
Other - Org Name:REJUVENE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-478-5790
Mailing Address - Street 1:531 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2605
Mailing Address - Country:US
Mailing Address - Phone:904-687-3021
Mailing Address - Fax:
Practice Address - Street 1:531 S 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2605
Practice Address - Country:US
Practice Address - Phone:904-478-5790
Practice Address - Fax:904-375-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty