=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790607687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPLIFTHRT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2026
-----------------------------------------------------
Last Update Date | 07/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7035 GULLOTTI PL
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-775-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7035 GULLOTTI PL
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-775-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MA
-----------------------------------------------------
Name | JAMES MARTELLO
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 772-775-2880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------