=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346560307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCH PRO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2443 JACKSON ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-270-2574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2443 JACKSON ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-270-2574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LINDA SUE MILANO
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 954-270-2574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 1707182
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------