1851164644 NPI number — HEALTHY MINDS WELLNESS GROUP, PLLC

Table of content: (NPI 1851164644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851164644 NPI number — HEALTHY MINDS WELLNESS GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY MINDS WELLNESS GROUP, PLLC
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:
1851164644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10519 BERMUDA ISLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-607-4289
Provider Business Mailing Address Fax Number:
813-291-7529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10025 W HILLSBOROUGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33615-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-607-4289
Provider Business Practice Location Address Fax Number:
813-291-7529
Provider Enumeration Date:
11/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
KASENETZ
Authorized Official First Name:
PAOLA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-607-4289

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119486300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com