| Empressiv Glow Hydration and Wellness LLC | |
|
27251 Wesley Chapel Blvd Suite 1155 Wesley Chapel FL 33544-4285 | |
| (813) 578-7438 | |
| (813) 537-8858 |
| Full Name | Empressiv Glow Hydration and Wellness LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 27251 Wesley Chapel Blvd, Wesley Chapel, Florida |
| Authorized Official Name and Position | Nicole Rashel Kennerly (OWNER) |
| Authorized Official Contact | 8135787438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empressiv Glow Hydration and Wellness LLC 27251 Wesley Chapel Blvd Wesley Chapel FL 33544-4285 Ph: (813) 578-7438 | Empressiv Glow Hydration and Wellness LLC 27251 Wesley Chapel Blvd Suite 1155 Wesley Chapel FL 33544-4285 Ph: (813) 578-7438 |
| NPI Number | 1780381806 |
|---|---|
| Provider Enumeration Date | 02/09/2023 |
| Last Update Date | 02/25/2025 |
| Certification Date | 02/25/2025 |
| Medicare PECOS PAC ID | 4587173729 |
|---|---|
| Medicare Enrollment ID | O20250530001793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780381806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Nicole R Kennerly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275164477 PECOS PAC ID: 3870920291 Enrollment ID: I20200225001471 |
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