Healthcare Provider Details

I. General information

NPI: 1104910868
Provider Name (Legal Business Name): IMPOWER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 N RONALD REAGAN BLVD STE 116
LONGWOOD FL
32750-3534
US

IV. Provider business mailing address

2290 N RONALD REAGAN BLVD STE 116
LONGWOOD FL
32750-3534
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-8002
  • Fax: 407-331-8659
Mailing address:
  • Phone: 407-215-0095
  • Fax: 407-261-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA MARIE KESIC
Title or Position: CEO
Credential:
Phone: 407-215-0095