Healthcare Provider Details

I. General information

NPI: 1861301855
Provider Name (Legal Business Name): MIND MEDICAL WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 CAPITAL CIR NE STE 6
TALLAHASSEE FL
32308-4110
US

IV. Provider business mailing address

1451 S 66TH AVE
HOLLYWOOD FL
33023-2101
US

V. Phone/Fax

Practice location:
  • Phone: 754-581-7994
  • Fax:
Mailing address:
  • Phone: 754-581-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARINE MARIA QUIVES
Title or Position: MANAGER
Credential: NURSE PRACTITIONER
Phone: 754-581-7994