Healthcare Provider Details

I. General information

NPI: 1174443048
Provider Name (Legal Business Name): LUNARA PSYCHIATRY AND HOLISTIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BEXLEY DRIVE
TAVARES FL
32778
US

IV. Provider business mailing address

2400 BEXLEY DR
TAVARES FL
32778-5760
US

V. Phone/Fax

Practice location:
  • Phone: 352-729-1231
  • Fax:
Mailing address:
  • Phone: 732-809-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAROLINA AMADOR
Title or Position: OWNER
Credential: PMHNP-BC, AGPCNP,-BC
Phone: 352-729-1231