Provider Demographics
NPI:1811432610
Name:PRIVATE PSYCHIATRY OF SOUTH WEST FLORIDA. INC
Entity type:Organization
Organization Name:PRIVATE PSYCHIATRY OF SOUTH WEST FLORIDA. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-900-1111
Mailing Address - Street 1:5454 LENA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9499
Mailing Address - Country:US
Mailing Address - Phone:941-900-1111
Mailing Address - Fax:941-201-4856
Practice Address - Street 1:5454 LENA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9499
Practice Address - Country:US
Practice Address - Phone:941-900-1111
Practice Address - Fax:941-201-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty