Healthcare Provider Details

I. General information

NPI: 1588580898
Provider Name (Legal Business Name): INNER SPARK MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 WATCHTOWER DR
ORMOND BEACH FL
32176-2886
US

IV. Provider business mailing address

26 WATCHTOWER DR
ORMOND BEACH FL
32176-2886
US

V. Phone/Fax

Practice location:
  • Phone: 386-588-5668
  • Fax: 386-200-4156
Mailing address:
  • Phone: 386-588-5668
  • Fax: 386-200-4156

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: CARLA HILL
Title or Position: OWNER, CEO
Credential: APRN, PMHNP-BC
Phone: 386-588-5668