Healthcare Provider Details

I. General information

NPI: 1144940735
Provider Name (Legal Business Name): ELEANOR HEALTH PROFESSIONAL FL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 GUNN HWY STE 160
TAMPA FL
33618-8786
US

IV. Provider business mailing address

PO BOX 386
PORTSMOUTH NH
03802-0386
US

V. Phone/Fax

Practice location:
  • Phone: 866-402-7631
  • Fax:
Mailing address:
  • Phone: 919-765-8744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NZGINGA HARRISON
Title or Position: CO-FOUNDER
Credential:
Phone: 617-419-0858