Provider Demographics
NPI:1780381806
Name:EMPRESSIV GLOW HYDRATION AND WELLNESS LLC
Entity type:Organization
Organization Name:EMPRESSIV GLOW HYDRATION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RASHEL
Authorized Official - Last Name:KENNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-578-7438
Mailing Address - Street 1:27251 WESLEY CHAPEL BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4285
Mailing Address - Country:US
Mailing Address - Phone:813-578-7438
Mailing Address - Fax:813-537-8858
Practice Address - Street 1:27251 WESLEY CHAPEL BLVD
Practice Address - Street 2:SUITE 1155
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4285
Practice Address - Country:US
Practice Address - Phone:813-578-7438
Practice Address - Fax:813-537-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty