MEDICARE: CONVERSE 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	:	1437928637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVERSE PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	4931 CAMELOT ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-3321
Country	:	US
Telephone Number	:	754-245-5480
Fax Number	:	941-300-6153

Provider Business Practice Location Address
First Line	:	4931 CAMELOT ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-3321
Country	:	US
Telephone Number	:	754-245-5480
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	DENIESE WILLIAMS
Credential	:
Telephone Number	:	754-245-5480

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	01/20/2026

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