Healthcare Provider Details

I. General information

NPI: 1922719814
Provider Name (Legal Business Name): SUMMER FLYNN APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RADISSON PLAZA 8TH FLOOR
NEW ROCHELLE NY
10801-5766
US

IV. Provider business mailing address

200 CONNER CT
ST JOHNS FL
32259-1902
US

V. Phone/Fax

Practice location:
  • Phone: 332-215-6631
  • Fax: 914-999-6022
Mailing address:
  • Phone: 332-215-6631
  • Fax: 914-999-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01446900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9322814
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: