Healthcare Provider Details

I. General information

NPI: 1659297943
Provider Name (Legal Business Name): RESTORATIVE MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S BROAD ST
BROOKSVILLE FL
34601-3106
US

IV. Provider business mailing address

12377 JAYBIRD RD
WEEKI WACHEE FL
34614-3247
US

V. Phone/Fax

Practice location:
  • Phone: 352-739-4605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN ORTIZ
Title or Position: APRN, OWNER
Credential:
Phone: 352-739-4605