Healthcare Provider Details

I. General information

NPI: 1720905284
Provider Name (Legal Business Name): MINDBRIDGE HEALTH AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 OAKFIELD DR
BRANDON FL
33511-4862
US

IV. Provider business mailing address

1389 OAKFIELD DR
BRANDON FL
33511-4862
US

V. Phone/Fax

Practice location:
  • Phone: 813-437-9726
  • Fax: 813-200-2659
Mailing address:
  • Phone: 813-437-9726
  • Fax: 813-200-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAVIER HERNANDEZ PEREZ
Title or Position: OWNER
Credential: FNP, PMHNP
Phone: 813-437-9726