Provider Demographics
NPI:1578309902
Name:EMPOWER LIFESTYLE MEDICINE PLLC
Entity type:Organization
Organization Name:EMPOWER LIFESTYLE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VOLHA
Authorized Official - Middle Name:
Authorized Official - Last Name:IHNATSENKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-682-5306
Mailing Address - Street 1:9200 NW 39TH AVE STE 130
Mailing Address - Street 2:PO BOX 3239
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7366
Mailing Address - Country:US
Mailing Address - Phone:352-682-5640
Mailing Address - Fax:
Practice Address - Street 1:5208 SW 91ST DR STE E
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9117
Practice Address - Country:US
Practice Address - Phone:352-200-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty