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General NPI Number Information
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NPI Number | 1063919637
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND--BEACHSIDE
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 198 VINING CT # 5
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City | ORMOND BEACH
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State | FL
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Zip | 32176-6658
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Country | US
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Telephone | 386-256-5553
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Fax | 386-256-5553
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Provider Business Mailing Address
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Address Line | 198 VINING CT # 5
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City | ORMOND BEACH
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State | FL
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Zip | 32176-6658
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Country | US
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Telephone | 386-256-5553
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Fax | 386-256-5553
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Authorized Official
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Title or Position | MANAGER
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Name | MELISSA GAD
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Credential | APRN
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Telephone | 386-262-5197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9355262
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License Number State | FL
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