Provider Demographics
NPI:1902378581
Name:REVITAL HEALTH AND WELLNESS CLINICS PLLC
Entity Type:Organization
Organization Name:REVITAL HEALTH AND WELLNESS CLINICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:SWEAT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-768-5552
Mailing Address - Street 1:695 PRESIDENT PL STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5681
Mailing Address - Country:US
Mailing Address - Phone:615-768-5552
Mailing Address - Fax:615-768-5583
Practice Address - Street 1:695 PRESIDENT PL STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5681
Practice Address - Country:US
Practice Address - Phone:615-768-5552
Practice Address - Fax:615-768-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty