Healthcare Provider Details

I. General information

NPI: 1891339610
Provider Name (Legal Business Name): YSANDA MELINDA PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

11682 MEMORIAL DR
BROOKSVILLE FL
34613-1218
US

V. Phone/Fax

Practice location:
  • Phone: 813-500-0773
  • Fax:
Mailing address:
  • Phone: 813-500-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.032107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: