Healthcare Provider Details

I. General information

NPI: 1881542512
Provider Name (Legal Business Name): MIND-FULL PSYCHIATRIC WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 ALT. US-19 N SUITE 604-7
PALM HARBOR FL
34683
US

IV. Provider business mailing address

3905 HASTINGS CT APT 102
PALM HARBOR FL
34685-6123
US

V. Phone/Fax

Practice location:
  • Phone: 727-377-9313
  • Fax:
Mailing address:
  • Phone: 727-512-7751
  • Fax:

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: ASHLEY HENRY
Title or Position: FOUNDER/OWNER
Credential: APRN, PMHNP-BC
Phone: 727-512-7751