Organization
RENEW RESTORE REVISE PSYCHIATRIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHINIKA CLARK APRN (OWNER)
(386) 585-2144
Entity
Organization
Contact information
Practice address
25 FLORIDA PARK DR N STE E, PALM COAST, FL 32137-3806
(386) 585-2144
(386) 206-5386
Mailing address
PO BOX 45, ST AUGUSTINE, FL 32085-0045
(386) 585-2144
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
10/01/2025
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