Provider Demographics
NPI:1710654413
Name:V&R REJUVENATION DRIP BAR LLC
Entity Type:Organization
Organization Name:V&R REJUVENATION DRIP BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDALYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:850-260-2684
Mailing Address - Street 1:1119 IOLA DR
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6302
Mailing Address - Country:US
Mailing Address - Phone:850-260-2684
Mailing Address - Fax:
Practice Address - Street 1:1119 IOLA DR
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6302
Practice Address - Country:US
Practice Address - Phone:850-260-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty