Provider Demographics
NPI:1649578055
Name:PSYCHIATRIC PROFESSIONAL CARE, INC
Entity Type:Organization
Organization Name:PSYCHIATRIC PROFESSIONAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MILANO
Authorized Official - Suffix:
Authorized Official - Credentials:A,RNP
Authorized Official - Phone:954-270-2574
Mailing Address - Street 1:2443 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4928
Mailing Address - Country:US
Mailing Address - Phone:954-270-2574
Mailing Address - Fax:
Practice Address - Street 1:2443 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4928
Practice Address - Country:US
Practice Address - Phone:954-270-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8166Medicare UPIN