Provider Demographics
NPI:1255109310
Name:EDEN PSYCHIATRY HEALTH PROFESSIONAL LIM
Entity type:Organization
Organization Name:EDEN PSYCHIATRY HEALTH PROFESSIONAL LIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:LOVANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:239-380-3728
Mailing Address - Street 1:941 TAMIAMI TRL STE C
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3121
Mailing Address - Country:US
Mailing Address - Phone:239-380-3728
Mailing Address - Fax:
Practice Address - Street 1:941 TAMIAMI TRL STE C
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3121
Practice Address - Country:US
Practice Address - Phone:239-380-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service