Provider Demographics
NPI:1073265617
Name:ENLIVEN INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:ENLIVEN INTEGRATIVE HEALTH
Other - Org Name:FLORIDA INTEGRATIVE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:727-329-8859
Mailing Address - Street 1:100 2ND AVE S STE 904S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4354
Mailing Address - Country:US
Mailing Address - Phone:727-329-8859
Mailing Address - Fax:
Practice Address - Street 1:100 2ND AVE S STE 904S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4354
Practice Address - Country:US
Practice Address - Phone:727-329-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty