# SWFL SCIENTIFIC REJUVENATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023786928
- **Authorized official:** RAE ANN ANTONUCCI PA (OWNER)
- **Authorized official phone:** (941) 662-6750

## Contact information

- **Practice address:** 122 NESBIT ST, PUNTA GORDA, FL 33950-3653
- **Practice address phone:** (239) 270-2882
- **Mailing address:** 122 NESBIT ST, PUNTA GORDA, FL 33950-3653
- **Mailing address phone:** (239) 270-2882

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/03/2021
- **Last updated:** 09/03/2021