=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013712827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR SOLUTIONS MIND & BODY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1344 S APOLLO BLVD STE 2C
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-3183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-249-2677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5835 BRABROOK AVE
-----------------------------------------------------
City | GRANT VALKARIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32949-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-249-2677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. TAMI LEEBERG
-----------------------------------------------------
Credential | AGPCNP
-----------------------------------------------------
Telephone | 321-249-2677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------