Healthcare Provider Details

I. General information

NPI: 1740158872
Provider Name (Legal Business Name): PSYCHIATRIC MENTAL HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 ALT 19
PALM HARBOR FL
34683-1926
US

IV. Provider business mailing address

4424 WORTHINGTON CIR
PALM HARBOR FL
34685-1158
US

V. Phone/Fax

Practice location:
  • Phone: 727-772-0038
  • Fax: 727-787-2384
Mailing address:
  • Phone: 727-504-7073
  • Fax: 727-787-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK E HICKEY
Title or Position: PRESIDENT
Credential: APRN/PMHNP
Phone: 727-504-7073