1568151926 NPI number — PRACTICAL PSYCHIATRIC SOLUTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568151926 NPI number — PRACTICAL PSYCHIATRIC SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRACTICAL PSYCHIATRIC SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568151926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15985 PRESERVE MARKETPLACE BLVD
Provider Second Line Business Mailing Address:
#246
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-616-1663
Provider Business Mailing Address Fax Number:
727-677-0940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3634 BENERAID STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAND O LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-637-9518
Provider Business Practice Location Address Fax Number:
727-677-0940
Provider Enumeration Date:
05/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DEUTSCHER
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
813-616-1663

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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