Organization
SWFL SCIENTIFIC REJUVENATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAE ANN ANTONUCCI PA (OWNER)
(941) 662-6750
Entity
Organization
Contact information
Practice address
122 NESBIT ST, PUNTA GORDA, FL 33950-3653
(239) 270-2882
Mailing address
122 NESBIT ST, PUNTA GORDA, FL 33950-3653
(239) 270-2882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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