Healthcare Provider Details

I. General information

NPI: 1407690530
Provider Name (Legal Business Name): SERENITY MENTAL HEALTH SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W TACON ST
TAMPA FL
33629-7929
US

IV. Provider business mailing address

3502 W TACON ST
TAMPA FL
33629-7929
US

V. Phone/Fax

Practice location:
  • Phone: 727-488-1452
  • Fax:
Mailing address:
  • Phone: 727-488-1452
  • Fax: 727-231-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IRINA A VANGELOV
Title or Position: APRN
Credential: NP
Phone: 727-488-1452