Healthcare Provider Details

I. General information

NPI: 1003771684
Provider Name (Legal Business Name): GROW WELL PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7795 117TH ST
SEMINOLE FL
33772-5223
US

IV. Provider business mailing address

7795 117TH ST
SEMINOLE FL
33772-5223
US

V. Phone/Fax

Practice location:
  • Phone: 727-418-2120
  • Fax: 352-820-4133
Mailing address:
  • Phone: 727-418-2120
  • Fax: 352-820-4133

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: JILL MORAN
Title or Position: PMHNP
Credential: APRN
Phone: 727-418-2120