Innerglow Empowered Wellness, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

INNERGLOW EMPOWERED WELLNESS, LLC

Practice address

13011 Summerfield Square Dr
Riverview, FL 33578-7402

Phone

(813) 404-4229

NPI assigned

Apr 29, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Serena WilliamsNPI 1053099002

Title

Owner

Phone

(813) 404-4229

Specialties & licenses 1

Addresses

Other names 1

• Medi Weight Loss Clinics Riverview Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Serena Williams

  • Case Manager/Care Coordinator
  • Tampa, FL
  • NPI 1053099002
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1245028109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13011 SUMMERFIELD SQUARE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335787402",
            "telephone_number": "813-404-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13011 SUMMERFIELD SQUARE DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335787402",
            "telephone_number": "813-404-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERGLOW EMPOWERED WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SERENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-404-4229"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Weight Loss Clinics Riverview",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Riverview, FL
• Providers in Riverview, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.