Organization
REVIVE PRIMARY CARE AND MEDSPA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI M MARLOW NURSE PRACTITIONER (AGNP-CB)
(937) 408-7606
Entity
Organization
Contact information
Practice address
2221 JACKSBORO PIKE STE A18, LA FOLLETTE, TN 37766-3035
(937) 408-7606
(865) 332-1923
Mailing address
2221 JACKSBORO PIKE STE A18, LA FOLLETTE, TN 37766-3035
(937) 408-7606
(865) 332-1923
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/10/2026
Last updated
02/10/2026
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