Organization
AGELESS DYNAMICS , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI KHRISTINE AXFORD NURSE PRACTITIONER (OWNER)
(425) 971-0990
Entity
Organization
Contact information
Practice address
9200 NW 39TH AVE STE 130-3170, GAINESVILLE, FL 32606-7331
(352) 201-3701
Mailing address
9200 NW 39TH AVE STE 130-3170, GAINESVILLE, FL 32606-7331
(352) 201-3701
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
10/06/2021
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