Healthcare Provider Details

I. General information

NPI: 1023934924
Provider Name (Legal Business Name): MINDFUL PSYCHIATRY AND WEIGHT WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 NW 53RD AVE STE B
GAINESVILLE FL
32653-4804
US

IV. Provider business mailing address

4723 NW 53RD AVE STE B
GAINESVILLE FL
32653-4804
US

V. Phone/Fax

Practice location:
  • Phone: 352-707-8188
  • Fax: 352-743-1933
Mailing address:
  • Phone: 352-707-8188
  • Fax: 352-743-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH GOLDBERG
Title or Position: OWNER
Credential: APRN
Phone: 352-494-6940