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General NPI Number Information
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NPI Number | 1780381806
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Entity Type | Organization
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Legal Business Name | EMPRESSIV GLOW HYDRATION AND WELLNESS LLC
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 27251 WESLEY CHAPEL BLVD SUITE 1155
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-4285
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Country | US
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Telephone | 813-578-7438
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Fax | 813-537-8858
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Provider Business Mailing Address
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Address Line | 27251 WESLEY CHAPEL BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-4285
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Country | US
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Telephone | 813-578-7438
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Fax | 813-537-8858
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE RASHEL KENNERLY
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Credential |
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Telephone | 813-578-7438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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