Organization
AGELESS DYNAMICS LLC HYDRATE AND RENEW IV SOLUTIONS
Active
Other names
Ageless Dynamics LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LORI KHRISTINE AXFORD (OWNER / PRACTITIONER)
(425) 971-0990
Entity
Organization
Contact information
Practice address
19757 THE PLACE BLVD, ESTERO, FL 33928-6608
(425) 971-0990
Mailing address
19757 THE PLACE BLVD, ESTERO, FL 33928-6608
(425) 971-0990
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/24/2025
Last updated
04/24/2025
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