Healthcare Provider Details

I. General information

NPI: 1922973049
Provider Name (Legal Business Name): IMPERIUM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N WICKHAM RD
MELBOURNE FL
32940-2028
US

IV. Provider business mailing address

6300 N WICKHAM RD
MELBOURNE FL
32940-2028
US

V. Phone/Fax

Practice location:
  • Phone: 321-795-1156
  • Fax: 321-422-4500
Mailing address:
  • Phone: 321-795-1156
  • Fax: 321-422-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRIDGETT EVETTE WILLIAMS-COOPER
Title or Position: OWNER
Credential: ARNP
Phone: 321-795-1156