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General NPI Number Information
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NPI Number | 1578387817
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Entity Type | Organization
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Legal Business Name | EPIPHANY INTEGRATED HEALTH
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1990 MAIN ST STE 750
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City | SARASOTA
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State | FL
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Zip | 34236-8000
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Country | US
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Telephone | 941-367-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 1990 MAIN ST STE 750
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City | SARASOTA
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State | FL
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Zip | 34236-8000
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Country | US
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Telephone | 941-367-2356
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. MATELAND KEITH III
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Credential | MS, APRN, PMHNP-BC
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Telephone | 941-367-2356
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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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