AGELESS DYNAMICS LLC NPI 1922777390

NPI Information

NPI: 1922777390
Provider Name: AGELESS DYNAMICS , LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 10D2237554

Address:
9200 NW 39TH AVE STE 130-3170
GAINESVILLE, FL
ZIP 32606
Phone: (352) 201-3701
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AGELESS DYNAMICS , LLC is a primary care clinic center in Gainesville, FL. AGELESS DYNAMICS , LLC NPI is 1922777390. The provider is registered as an organization entity type.

The provider's business location address is:

9200 NW 39TH AVE STE 130-3170
GAINESVILLE, FL
ZIP 32606-331
Phone: (352) 201-3701

The provider's authorized official is Lori Khristine Axford .
The authorized official title is Owner and has the following contact phone number (425) 971-0990.

The CLIA number assigned to this NPI record is 10D2237554 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/9/2021 and was last updated on 10/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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