Healthcare Provider Details

I. General information

NPI: 1720907926
Provider Name (Legal Business Name): LEGENDARY MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31308 AMBERVIEW BND
WESLEY CHAPEL FL
33545-4516
US

IV. Provider business mailing address

31308 AMBERVIEW BND
WESLEY CHAPEL FL
33545-4516
US

V. Phone/Fax

Practice location:
  • Phone: 813-710-5746
  • Fax:
Mailing address:
  • Phone: 813-710-5746
  • 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: JESSICA DWANNA DAVIS
Title or Position: CEO
Credential: DNP, PMHNP-BC
Phone: 318-562-8066