Provider Demographics
NPI:1720799471
Name:VONETTA NICOLE PSYCHIATRY
Entity Type:Organization
Organization Name:VONETTA NICOLE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VONETTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ERSKINE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:772-708-9728
Mailing Address - Street 1:1345 N FALKENBURG RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-0945
Mailing Address - Country:US
Mailing Address - Phone:813-388-8189
Mailing Address - Fax:813-537-8718
Practice Address - Street 1:1345 N FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-0945
Practice Address - Country:US
Practice Address - Phone:813-388-8189
Practice Address - Fax:813-537-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111656100Medicaid