Healthcare Provider Details

I. General information

NPI: 1578425781
Provider Name (Legal Business Name): WHOLE MIND FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 EXECUTIVE PARK DR STE 101
WESTON FL
33331-3656
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-7189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA SHARP
Title or Position: BILLING & CREDENTIALING SPECIALIST
Credential: CREDENTIALING
Phone: 385-323-9067