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General NPI Number Information
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NPI Number | 1134995426
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Entity Type | Organization
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Legal Business Name | REVITALIZE PSYCHIATRIC SERVICES II, INC.
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 27524 CASHFORD CIR STE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6947
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Country | US
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Telephone | 815-212-1478
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Fax | 813-906-7789
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Provider Business Mailing Address
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Address Line | 11919 CASTINE ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-1807
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Country | US
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Telephone | 815-212-1478
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLY LYNN HUFFMAN
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Credential | DNP, ARNP, PMHNP-BC
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Telephone | 815-212-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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