Healthcare Provider Details

I. General information

NPI: 1306685003
Provider Name (Legal Business Name): ADVANCED PRACTICE SKILLS WORKSHOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 PEARSON JAMES PLACE
LUTZ FL
33559
US

IV. Provider business mailing address

PO BOX 47475
TAMPA FL
33646-0113
US

V. Phone/Fax

Practice location:
  • Phone: 813-428-5295
  • Fax:
Mailing address:
  • Phone: 404-370-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA R EVANS
Title or Position: CO-OWNER
Credential: APRN
Phone: 404-370-2158