Healthcare Provider Details

I. General information

NPI: 1124941604
Provider Name (Legal Business Name): UNBOUND MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20234 POND APPLE LN
TAMPA FL
33647-3489
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD # 1535
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 239-297-8807
  • Fax:
Mailing address:
  • Phone: 239-297-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY NICOLE MCDONALD
Title or Position: PMHNP
Credential: APRN
Phone: 239-297-8807