# EMPRESSIV GLOW HYDRATION AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780381806
- **Authorized official:** NICOLE RASHEL KENNERLY (OWNER)
- **Authorized official phone:** (813) 578-7438

## Contact information

- **Practice address:** 27251 WESLEY CHAPEL BLVD, SUITE 1155, WESLEY CHAPEL, FL 33544-4285
- **Practice address phone:** (813) 578-7438
- **Practice address fax:** (813) 537-8858
- **Mailing address:** 27251 WESLEY CHAPEL BLVD, WESLEY CHAPEL, FL 33544-4285
- **Mailing address phone:** (813) 578-7438
- **Mailing address fax:** (813) 537-8858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2023
- **Last updated:** 02/25/2025