Healthcare Provider Details

I. General information

NPI: 1134992688
Provider Name (Legal Business Name): NXPATH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 NW FEDERAL HWY
STUART FL
34994-9629
US

IV. Provider business mailing address

6911 PISTOL RANGE RD
TAMPA FL
33635-6335
US

V. Phone/Fax

Practice location:
  • Phone: 772-480-5860
  • Fax:
Mailing address:
  • Phone: 813-325-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN SHOOK
Title or Position: PRESIDENT
Credential:
Phone: 813-325-7479