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Organization

LIVEACTIVE PRIMARY CARE TAMPA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHANE BRETHOWR (CEO/AUTHORIZED OFFICIAL)
(913) 549-3884
Entity
Organization

Contact information

Practice address
8849 HAWBUCK ST STE A, NEW PORT RICHEY, FL 34655-9805
(913) 549-3884
Mailing address
PO BOX 1269, BELLEVUE, NE 68005-1269

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Enumeration date
09/02/2025
Last updated
09/02/2025
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