Healthcare Provider Details

I. General information

NPI: 1427960624
Provider Name (Legal Business Name): ROOTS & WINGS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 LEMA DR
SPRING HILL FL
34609-2814
US

IV. Provider business mailing address

3490 LEMA DR
SPRING HILL FL
34609-2814
US

V. Phone/Fax

Practice location:
  • Phone: 813-729-3870
  • Fax:
Mailing address:
  • Phone:
  • 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: MRS. TONYA SUZETTE MARRERO
Title or Position: MGR
Credential: PMHNP-BC
Phone: 813-729-3870