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General NPI Number Information
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NPI Number | 1508701731
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE PSYCHIATRIC CARE & WELLNESS LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 600 S MAIN AVE UNIT 100
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City | MINNEOLA
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State | FL
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Zip | 34715-9578
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Country | US
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Telephone | 352-703-6341
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Fax | 352-743-1153
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | MINNEOLA
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State | FL
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Zip | 34755-0203
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Country | US
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Telephone | 352-703-6341
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Fax | 352-743-1153
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Authorized Official
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Title or Position | CO-OWNER
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Name | GEORGE P. CANNON
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Credential | APRN, PMHNP-BC
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Telephone | 305-546-3037
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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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