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General NPI Number Information
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NPI Number | 1255222097
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Entity Type | Organization
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Legal Business Name | STILL WATERS PSYCHIATRIC MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 35010 PROSPECT RD
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City | DADE CITY
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State | FL
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Zip | 33525-8210
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Country | US
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Telephone | 352-534-6970
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Fax |
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Provider Business Mailing Address
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Address Line | 35010 PROSPECT RD
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City | DADE CITY
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State | FL
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Zip | 33525-8210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SERVANT LEADER OF PEACE
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Name | ALEXANDRA REID
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Credential | PMHNP
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Telephone | 813-334-8635
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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 |
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License Number State |
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