Provider Demographics
NPI:1760166706
Name:KEYSTONE PSYCHIATRY INC
Entity Type:Organization
Organization Name:KEYSTONE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:TAZZIE
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN PMHNP-BC
Authorized Official - Phone:352-494-6692
Mailing Address - Street 1:2380 SE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-5822
Mailing Address - Country:US
Mailing Address - Phone:352-494-6692
Mailing Address - Fax:352-558-3422
Practice Address - Street 1:275 S LAWRENCE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9473
Practice Address - Country:US
Practice Address - Phone:352-494-6692
Practice Address - Fax:352-558-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty