MEDICARE: THE MIND LAB PSYCHIATRY LLC

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	:	1437003621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MIND LAB PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	901 NW 8TH AVE
Second Line	:	SUITE B8 PMB 1058
City	:	GAINESVILLE
State	:	FL
Zip	:	32601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 SW ARCHER RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-2255
Country	:	US
Telephone Number	:	352-768-6192
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELISABETH KING
Credential	:	APRN
Telephone Number	:	561-573-0062

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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