Healthcare Provider Details

I. General information

NPI: 1316509185
Provider Name (Legal Business Name): HEALTHY MINDS & HEALING HEARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 RAY RD
VALRICO FL
33594-4619
US

IV. Provider business mailing address

2307 RAY RD
VALRICO FL
33594-4619
US

V. Phone/Fax

Practice location:
  • Phone: 813-300-0987
  • Fax:
Mailing address:
  • Phone: 813-300-0987
  • Fax: 855-975-3121

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: DAWN ADDISON
Title or Position: OWNER
Credential: ARNP
Phone: 813-300-0987