Healthcare Provider Details

I. General information

NPI: 1366357360
Provider Name (Legal Business Name): UTHRIVE TELEHEALTH & MOBILE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 W SAMPLE RD STE 300
CORAL SPRINGS FL
33065-3973
US

IV. Provider business mailing address

10100 W SAMPLE RD STE 300
CORAL SPRINGS FL
33065-3973
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-1211
  • Fax:
Mailing address:
  • Phone: 954-998-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ULRICK THEOC
Title or Position: MANAGING MEMBER
Credential: MSN, APRN, FNP-BC
Phone: 954-998-1211