=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366357360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UTHRIVE TELEHEALTH & MOBILE CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10100 W SAMPLE RD STE 300
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-3973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-998-1211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10100 W SAMPLE RD STE 300
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-3973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-998-1211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ULRICK THEOC
-----------------------------------------------------
Credential | MSN, APRN, FNP-BC
-----------------------------------------------------
Telephone | 954-998-1211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------