Provider Demographics
NPI:1013712827
Name:SENIOR SOLUTIONS MIND & BODY, LLC
Entity type:Organization
Organization Name:SENIOR SOLUTIONS MIND & BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP
Authorized Official - Phone:321-249-2677
Mailing Address - Street 1:5835 BRABROOK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT VALKARIA
Mailing Address - State:FL
Mailing Address - Zip Code:32949-2130
Mailing Address - Country:US
Mailing Address - Phone:321-249-2677
Mailing Address - Fax:
Practice Address - Street 1:1344 S APOLLO BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-249-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty