=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295690634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY MENTAL HEALTH PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 S RIVERSIDE DR STE 151
-----------------------------------------------------
City | INDIALANTIC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32903-4321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-327-4606
-----------------------------------------------------
Fax | 321-327-3278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 S RIVERSIDE DR STE 151
-----------------------------------------------------
City | INDIALANTIC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32903-4321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-327-4606
-----------------------------------------------------
Fax | 321-327-3278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RYAN C MYERS
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 865-246-8508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------