Healthcare Provider Details

I. General information

NPI: 1437003621
Provider Name (Legal Business Name): THE MIND LAB PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 SW ARCHER RD
GAINESVILLE FL
32608-2255
US

IV. Provider business mailing address

901 NW 8TH AVE SUITE B8 PMB 1058
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-768-6192
  • 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 State

VIII. Authorized Official

Name: ELISABETH KING
Title or Position: OWNER
Credential: APRN
Phone: 561-573-0062