Healthcare Provider Details

I. General information

NPI: 1962773549
Provider Name (Legal Business Name): OAKBROOK PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE SUITE 504
OCALA FL
34470-5675
US

IV. Provider business mailing address

1111 NE 25TH AVE SUITE 504
OCALA FL
34470-5675
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-2889
  • Fax:
Mailing address:
  • Phone: 352-351-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP283112
License Number StateFL

VIII. Authorized Official

Name: PAMELA CARROLL
Title or Position: ARNP
Credential: ARNP
Phone: 352-351-2889