Healthcare Provider Details

I. General information

NPI: 1982427175
Provider Name (Legal Business Name): MENTALYZE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 WAY POINT BLVD
HARMONY FL
34773-6160
US

IV. Provider business mailing address

7901 4TH ST N # 24297
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 561-757-4200
  • Fax:
Mailing address:
  • Phone: 561-757-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC PALMER
Title or Position: MANAGER
Credential: ARNP, PMHNP, FNP DNP
Phone: 561-757-4200