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General NPI Number Information
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NPI Number | 1518634054
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Entity Type | Organization
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Legal Business Name | DAVENPORT BEHAVIORAL CENTER LLC
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 19 N 6TH STREET 19A
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City | HAINES CITY
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State | FL
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Zip | 33844
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Country | US
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Telephone | 321-663-6375
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Fax |
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Provider Business Mailing Address
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Address Line | 109 AMBERSWEET WAY
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City | DAVENPORT
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State | FL
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Zip | 33897-8418
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Country | US
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Telephone | 321-663-6375
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. FRAINELYS CRUZ
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Credential | PMHNP
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Telephone | 321-278-4084
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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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