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General NPI Number Information
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NPI Number | 1578373288
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Entity Type | Organization
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Legal Business Name | MOSAIC LOTUS INTEGRATIVE PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1112 THOMASVILLE RD STE 3
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6534
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Country | US
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Telephone | 919-605-6309
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 ABBOTSFORD WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32312-2801
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Country | US
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Telephone | 919-605-6309
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Fax |
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Authorized Official
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Title or Position | CEO/APRN
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Name | KRISTI ANNA MYERS
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Credential | APRN
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Telephone | 919-605-6309
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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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