Individual
JESSE REVENIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6500 W NEWBERRY RD, GAINESVILLE, FL 32605-4309
(352) 333-4000
Mailing address
8075 NW 39TH AVE APT 301, GAINESVILLE, FL 32606-0026
(941) 402-9829
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME160015
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
FL
Other
Enumeration date
03/18/2019
Last updated
07/31/2023
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