Provider Demographics
NPI:1619223468
Name:TRANQUIL MIND PLC
Entity Type:Organization
Organization Name:TRANQUIL MIND PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:407-491-1818
Mailing Address - Street 1:PO BOX 620321
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-0321
Mailing Address - Country:US
Mailing Address - Phone:407-491-1818
Mailing Address - Fax:407-745-0598
Practice Address - Street 1:1858 N ALAFAYA TRL
Practice Address - Street 2:STE. 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4728
Practice Address - Country:US
Practice Address - Phone:407-491-1818
Practice Address - Fax:407-745-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW104251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03982200Medicaid
FLFI963AMedicare PIN