Provider Demographics
NPI:1669137964
Name:FLORIDA PSYCARE, LLC
Entity type:Organization
Organization Name:FLORIDA PSYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-516-8991
Mailing Address - Street 1:340 SAPPHIRE LAKE DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3445
Mailing Address - Country:US
Mailing Address - Phone:352-516-8991
Mailing Address - Fax:954-206-0526
Practice Address - Street 1:340 SAPPHIRE LAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3445
Practice Address - Country:US
Practice Address - Phone:352-516-8991
Practice Address - Fax:954-206-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty