Healthcare Provider Details

I. General information

NPI: 1790607687
Provider Name (Legal Business Name): UPLIFTHRT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 GULLOTTI PL
PORT ST LUCIE FL
34952-2905
US

IV. Provider business mailing address

7035 GULLOTTI PL
PORT ST LUCIE FL
34952-2905
US

V. Phone/Fax

Practice location:
  • Phone: 772-775-2880
  • Fax:
Mailing address:
  • Phone: 772-775-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES MARTELLO
Title or Position: MA
Credential: MA
Phone: 772-775-2880