Provider Demographics
NPI:1770976698
Name:GROWING MIND HEALTH AND WELLNESS
Entity type:Organization
Organization Name:GROWING MIND HEALTH AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:407-489-0426
Mailing Address - Street 1:7901 KINGSPOINTE PKWY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-6520
Mailing Address - Country:US
Mailing Address - Phone:407-489-0426
Mailing Address - Fax:407-210-6838
Practice Address - Street 1:9340 MUSTARD LEAF DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7082
Practice Address - Country:US
Practice Address - Phone:407-489-0426
Practice Address - Fax:407-210-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9214022363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty