Provider Demographics
NPI:1083303127
Name:UTHRIVEHEALTH
Entity Type:Organization
Organization Name:UTHRIVEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN, PMHNP-BC, FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:GENCI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKEMBI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-515-3008
Mailing Address - Street 1:5411 GRAND BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4010
Mailing Address - Country:US
Mailing Address - Phone:813-515-3008
Mailing Address - Fax:
Practice Address - Street 1:5411 GRAND BLVD STE 109
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4010
Practice Address - Country:US
Practice Address - Phone:813-515-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care