Healthcare Provider Details

I. General information

NPI: 1073279287
Provider Name (Legal Business Name): ASSURED MENTAL & PHYSICAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 04/23/2024
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

673 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 813-797-6174
  • Fax: 813-336-8306
Mailing address:
  • Phone: 813-797-6174
  • Fax: 813-336-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDTRAIL FEET
Title or Position: OWNER
Credential: APRN
Phone: 813-797-6174