Provider Demographics
NPI:1174302699
Name:EMPOWER TATTOO LLC
Entity type:Organization
Organization Name:EMPOWER TATTOO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-461-2211
Mailing Address - Street 1:7575 DR PHILLIPS BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7220
Mailing Address - Country:US
Mailing Address - Phone:407-982-4876
Mailing Address - Fax:407-650-2754
Practice Address - Street 1:225 W SR 434 STE 205
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4980
Practice Address - Country:US
Practice Address - Phone:407-461-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty