Healthcare Provider Details

I. General information

NPI: 1144015645
Provider Name (Legal Business Name): TRANQUIL JOURNEY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 MONTIANO CIR
SAINT AUGUSTINE FL
32084-6576
US

IV. Provider business mailing address

83 MONTIANO CIR
SAINT AUGUSTINE FL
32084-6576
US

V. Phone/Fax

Practice location:
  • Phone: 904-840-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA PAULK
Title or Position: CONSULTANT
Credential:
Phone: 904-840-7643