MEDICARE: BANGASH PSYCHIATRY & WELLNESS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1386506186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANGASH PSYCHIATRY & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	802 E BAKER ST STE 2
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-3636
Country	:	US
Telephone Number	:	813-868-8694
Fax Number	:	813-822-4983

Provider Business Practice Location Address
First Line	:	802 E BAKER ST STE 2
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-3636
Country	:	US
Telephone Number	:	813-868-8694
Fax Number	:	813-822-4983

Authorized Official
Title or Position	:	CEO
Name	:	NUSRAT BANGASH
Credential	:	PMHNP-BC
Telephone Number	:	813-868-8694

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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