Healthcare Provider Details

I. General information

NPI: 1841126612
Provider Name (Legal Business Name): WHOLEMIND INTERGRATIVE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1894 SW 156TH AVE
MIRAMAR FL
33027-4321
US

IV. Provider business mailing address

1894 SW 156TH AVE
MIRAMAR FL
33027-4321
US

V. Phone/Fax

Practice location:
  • Phone: 954-495-8058
  • Fax: 954-495-8098
Mailing address:
  • Phone: 954-495-8058
  • Fax: 954-495-8098

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: MARTINE PHILLIPS
Title or Position: PROVIDER/ADMINISTRATOR
Credential: DNP, APRN
Phone: 954-495-8058