Healthcare Provider Details

I. General information

NPI: 1669318424
Provider Name (Legal Business Name): ORCHID BLOOM PSYCHIATRY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SE OCEAN BLVD STE 7
STUART FL
34994-2214
US

IV. Provider business mailing address

1 SE OCEAN BLVD STE 7
STUART FL
34994-2214
US

V. Phone/Fax

Practice location:
  • Phone: 772-919-9830
  • Fax: 772-519-5342
Mailing address:
  • Phone: 772-919-9830
  • Fax: 772-519-5342

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: MS. RENEE M BREITENBACH
Title or Position: OWNER
Credential: FNP-BC, PMHNP-BC
Phone: 772-418-0122