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General NPI Number Information
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NPI Number | 1356795629
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Entity Type | Organization
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Legal Business Name | FLORIDA PSYCH SERVICES INC.
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 13436 SW PEMBROKE CIR N
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City | LAKE SUZY
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State | FL
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Zip | 34269-6909
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Country | US
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Telephone | 239-478-7984
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Fax |
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Provider Business Mailing Address
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Address Line | 13436 SW PEMBROKE CIR N
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City | LAKE SUZY
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State | FL
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Zip | 34269-6909
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Country | US
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Telephone | 239-478-7984
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | COLLEEN SCUDDER
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Credential |
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Telephone | 239-478-7984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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