Healthcare Provider Details

I. General information

NPI: 1144135211
Provider Name (Legal Business Name): ELEVATED WELLNESS VIBES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13148 VAIL RIDGE DR
RIVERVIEW FL
33579-7187
US

IV. Provider business mailing address

13148 VAIL RIDGE DR
RIVERVIEW FL
33579-7187
US

V. Phone/Fax

Practice location:
  • Phone: 954-516-2748
  • Fax: 954-838-5419
Mailing address:
  • Phone: 954-516-2748
  • Fax: 954-838-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMBER RICO
Title or Position: PMHNP
Credential: APRN
Phone: 954-516-2748