Provider Demographics
NPI:1578113049
Name:SOFLO PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:SOFLO PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-601-3769
Mailing Address - Street 1:11997 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5571
Mailing Address - Country:US
Mailing Address - Phone:561-601-3769
Mailing Address - Fax:
Practice Address - Street 1:11997 N LAKE DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-5571
Practice Address - Country:US
Practice Address - Phone:561-601-3769
Practice Address - Fax:949-655-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty