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General NPI Number Information
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NPI Number | 1417898164
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Entity Type | Organization
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Legal Business Name | CBA ELITE MIND & BODY CARE, LLC
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Dates
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Enumeration Date | 04/04/2026
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Last Update Date | 04/04/2026
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Provider Practice Location Address
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Address Line | 1142 SW SUDDER AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1419
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Country | US
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Telephone | 413-745-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 NW SAINT LUCIE WEST BLVD # 1253
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2501
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Country | US
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Telephone | 413-735-3149
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CLAUDY BONNE ANNEE
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Credential | MD, APRN, PMHNP-BC
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Telephone | 413-735-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family 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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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