| Entity Name: | EMPOWER LIFESTYLE MEDICINE PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Mar 2024 (a year ago) |
| Document Number: | L24000117476 |
| FEI/EIN Number | 99-1726446 |
| Address: | 9200 NW 39TH AVE, STE 130 - 3239, GAINESVILLE, FL, 32606, UN |
| Mail Address: | 9200 NW 39TH AVE, STE 130 - 3239, GAINESVILLE, FL, 32606, UN |
| ZIP code: | 32606 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578309902 | 2024-07-04 | 2024-07-04 | 9200 NW 39TH AVE STE 130, PO BOX 3239, GAINESVILLE, FL, 326067366, US | 5208 SW 91ST DR STE E, GAINESVILLE, FL, 326089117, US | |||||||||||||||||||||||||||
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| Phone | +1 352-682-5640 |
| Phone | +1 352-200-2465 |
Authorized person
| Name | VOLHA IHNATSENKA |
| Role | MD |
| Phone | 3526825306 |
Taxonomy
| Taxonomy Code | 207QA0505X - Adult Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 2083B0002X - Obesity Medicine (Preventive Medicine) Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| YEUNG ANAMARIA | Agent | 9200 NW 39TH AVE, GAINESVILLE, FL, 32606 |
| Name | Role | Address |
|---|---|---|
| YEUNG ANAMARIA | Authorized Member | 9200 NW 39TH AVE STE 130-3239, GAINESVILLE, FL, 32606 |
| BYUN SHARON | Authorized Member | 9200 NW 39TH AVE STE 130-3239, GAINESVILLE, FL, 32606 |
| IHNATSENKA VOLHA | Authorized Member | 9200 NW 39TH AVE STE 130-3239, GAINESVILLE, FL, 32606 |
| COLEMAN RACHEL | Authorized Member | 9200 NW 39TH AVE STE 130-3239, GAINESVILLE, FL, 32606 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-03-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
