=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740914613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE FAMILY PSYCH & WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2022
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4388 COMMERCIAL WAY
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-278-6445
-----------------------------------------------------
Fax | 813-762-1388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4388 COMMERCIAL WAY
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-278-6445
-----------------------------------------------------
Fax | 813-762-1388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ ARNP
-----------------------------------------------------
Name | MRS. KIMBERLY MARIE HYMILLER
-----------------------------------------------------
Credential | MSN, ARNP, FNP-C
-----------------------------------------------------
Telephone | 727-278-6445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------