Healthcare Provider Details

I. General information

NPI: 1811738768
Provider Name (Legal Business Name): FITMIND THERAPEUTICS ADVANCED BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 613
JACKSONVILLE FL
32258-5214
US

IV. Provider business mailing address

12574 FLAGLER CENTER BLVD STE 101
JACKSONVILLE FL
32258-2615
US

V. Phone/Fax

Practice location:
  • Phone: 904-827-3714
  • Fax:
Mailing address:
  • Phone: 315-269-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA KOZEL
Title or Position: CEO
Credential: DNP, PMHNP-BC, FNP
Phone: 904-679-5439