Healthcare Provider Details

I. General information

NPI: 1588558274
Provider Name (Legal Business Name): BRANCH HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PLATT ST # 189
TAMPA FL
33606-2292
US

IV. Provider business mailing address

301 W PLATT ST # 189
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 813-416-9934
  • Fax:
Mailing address:
  • Phone: 813-416-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NATHANAEL GYURKE
Title or Position: EXECUTIVE CHAIRMAN
Credential:
Phone: 813-416-9934