Provider Demographics
NPI:1497224778
Name:PEACE OF MIND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PEACE OF MIND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:813-785-1551
Mailing Address - Street 1:12094 ANDERSON RD # 177
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5682
Mailing Address - Country:US
Mailing Address - Phone:813-316-6500
Mailing Address - Fax:
Practice Address - Street 1:5331 PRIMROSE LAKE CIR STE 112
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3764
Practice Address - Country:US
Practice Address - Phone:813-316-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008867000Medicaid