Healthcare Provider Details

I. General information

NPI: 1740944719
Provider Name (Legal Business Name): STILL WATERS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N RONALD REAGAN BLVD STE 204
LONGWOOD FL
32750-4162
US

IV. Provider business mailing address

1070 MONTGOMERY RD # 2247
ALTAMONTE SPRINGS FL
32714-7420
US

V. Phone/Fax

Practice location:
  • Phone: 407-974-6539
  • Fax:
Mailing address:
  • Phone: 407-974-6539
  • Fax: 407-550-7174

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: MR. GABRIEL ALVAREZ
Title or Position: APRN
Credential: APRN
Phone: 813-670-2649