Healthcare Provider Details

I. General information

NPI: 1134990583
Provider Name (Legal Business Name): ADAM KENNETH GOLIAS PMHNP-BC, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 N CLYDE MORRIS BLVD STE 140
DAYTONA BEACH FL
32117-5534
US

IV. Provider business mailing address

1737 N CLYDE MORRIS BLVD STE 140
DAYTONA BEACH FL
32117-5534
US

V. Phone/Fax

Practice location:
  • Phone: 386-262-1627
  • Fax:
Mailing address:
  • Phone: 386-262-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9591819
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: