Healthcare Provider Details

I. General information

NPI: 1417878067
Provider Name (Legal Business Name): LAUNCH POINT OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S COURTENAY PKWY STE 4A
MERRITT ISLAND FL
32952-4868
US

IV. Provider business mailing address

1510 MONTE CARLO CT
MERRITT ISLAND FL
32952-5666
US

V. Phone/Fax

Practice location:
  • Phone: 321-378-4707
  • Fax: 321-338-7062
Mailing address:
  • Phone: 321-378-4707
  • Fax: 321-338-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARI TILLMAN
Title or Position: OWNER
Credential: APRN
Phone: 321-378-4707