Healthcare Provider Details

I. General information

NPI: 1356795629
Provider Name (Legal Business Name): FLORIDA PSYCH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13436 SW PEMBROKE CIR N
LAKE SUZY FL
34269-6909
US

IV. Provider business mailing address

13436 SW PEMBROKE CIR N
LAKE SUZY FL
34269-6909
US

V. Phone/Fax

Practice location:
  • Phone: 239-478-7984
  • Fax:
Mailing address:
  • Phone: 239-478-7984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN SCUDDER
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 239-478-7984