MEDICARE: REVIVE N THRIVE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN11005058	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1215895750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE N THRIVE, PLLC

Provider Business Mailing Address
First Line	:	10632 SWEET SAPLING ST
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-6119
Country	:	US
Telephone Number	:	813-326-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	13414 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5706
Country	:	US
Telephone Number	:	813-326-9984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MECHELE COMBES
Credential	:	FNP-C, PMHNP-BC
Telephone Number	:	813-326-9984

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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