Healthcare Provider Details

I. General information

NPI: 1114896719
Provider Name (Legal Business Name): TIDE POINT HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 GRAND BAY BLVD
CLERMONT FL
34711-7855
US

IV. Provider business mailing address

11609 GRAND BAY BLVD
CLERMONT FL
34711-7855
US

V. Phone/Fax

Practice location:
  • Phone: 407-552-7136
  • Fax: 407-550-6387
Mailing address:
  • Phone: 407-552-7136
  • Fax: 407-550-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY KING
Title or Position: CEO
Credential: DNP, APRN
Phone: 407-552-7136