# RADIANT RECHARGE LLC

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

## Provider details

- **NPI number:** 1366204927
- **Authorized official:** JESSICA L FRAZIER RN (COO)
- **Authorized official phone:** (309) 712-1815

## Contact information

- **Practice address:** 466 SW PORT ST LUCIE BLVD STE 114, PORT ST LUCIE, FL 34953-2091
- **Practice address phone:** (772) 837-0500
- **Mailing address:** 6124 NW BUTTERFLY ORCHID PL, PORT ST LUCIE, FL 34986-3224
- **Mailing address phone:** (309) 712-1815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC1500X | Community Health Registered Nurse | — | NULL | — |
| 163WC1500X | Community Health Registered Nurse | — | — | — |
| 163WH0200X | Home Health Registered Nurse | — | NULL | Yes |
| 163WH0200X | Home Health Registered Nurse | — | — | Yes |
| 246RP1900X | Phlebotomy Technician | — | NULL | — |
| 246RP1900X | Phlebotomy Technician | — | — | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251K00000X | Public Health or Welfare Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/29/2024
- **Last updated:** 01/29/2024