Provider Demographics
NPI:1225309552
Name:PSYCHIATRIC ASSOCIATES OF SOUTHWEST FLORIDA
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF SOUTHWEST FLORIDA
Other - Org Name:PSYCHIATRIC ASSOCIATES OF SW FL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOJDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN APRN PMHNP
Authorized Official - Phone:239-332-4700
Mailing Address - Street 1:6804 PORTO FINO CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7139
Mailing Address - Country:US
Mailing Address - Phone:239-332-4700
Mailing Address - Fax:888-769-5641
Practice Address - Street 1:6804 PORTO FINO CIR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7139
Practice Address - Country:US
Practice Address - Phone:239-332-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFT516AMedicare PIN