Provider Demographics
NPI:1780465559
Name:ADVANCED REGENERATIVE HEALTH LLC
Entity type:Organization
Organization Name:ADVANCED REGENERATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:954-461-3172
Mailing Address - Street 1:1870 N CORPORATE LAKES BLVD UNIT 267021
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-8837
Mailing Address - Country:US
Mailing Address - Phone:754-268-3108
Mailing Address - Fax:
Practice Address - Street 1:5100 N FEDERAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3842
Practice Address - Country:US
Practice Address - Phone:754-268-3108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED REGENERATIVE HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty