Organization
REVIVEME HEALTHCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA TEJERA NURSE PRACTITIONER (MANAGING MEMBER)
(817) 964-8349
Entity
Organization
Contact information
Practice address
2637 FAIRMONT DR,, GRAND PRAIRIE, TX 75052-4009
(817) 964-8349
Mailing address
1301 E. DEBBIE LANE, SUITE 102, #1525, MANSFIELD, TX 76063-3376
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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