Organization
AGELESS REWIND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI WRAZIEN AGNP (OWNER/CEO)
(813) 460-6440
Entity
Organization
Contact information
Practice address
1911 BLUE RIVER RD, HOLIDAY, FL 34691-7849
(727) 320-7313
Mailing address
1911 BLUE RIVER RD, HOLIDAY, FL 34691-7849
(813) 360-1806
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/06/2024
Last updated
03/13/2025
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