| Renew Restore Revise Psychiatric Services, Llc | |
|
7901 4th St N St Petersburg FL 33702-4305 | |
| (386) 585-2144 | |
| Not Available |
| Full Name | Renew Restore Revise Psychiatric Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7901 4th St N, St Petersburg, Florida |
| Authorized Official Name and Position | Shinika Clark (OWNER) |
| Authorized Official Contact | 3865852144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Restore Revise Psychiatric Services, Llc Po Box 45 St Augustine FL 32085-0045 Ph: (386) 585-2144 | Renew Restore Revise Psychiatric Services, Llc 7901 4th St N St Petersburg FL 33702-4305 Ph: (386) 585-2144 |
| NPI Number | 1891516324 |
|---|---|
| Provider Enumeration Date | 10/17/2024 |
| Last Update Date | 10/17/2024 |
| Certification Date | 10/17/2024 |
| Medicare PECOS PAC ID | 4587193719 |
|---|---|
| Medicare Enrollment ID | O20250131003552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891516324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Shinika Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417679176 PECOS PAC ID: 5698130276 Enrollment ID: I20230504000555 |
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