Provider Demographics
NPI:1265019376
Name:ANXIETY TREATMENT OF FLORIDA LLC
Entity Type:Organization
Organization Name:ANXIETY TREATMENT OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-930-7670
Mailing Address - Street 1:PO BOX 2527
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-2527
Mailing Address - Country:US
Mailing Address - Phone:904-930-7670
Mailing Address - Fax:
Practice Address - Street 1:162 LONE EAGLE WAY
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8386
Practice Address - Country:US
Practice Address - Phone:904-930-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)