=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740944719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STILL WATERS PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2021
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N RONALD REAGAN BLVD STE 204
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32750-4162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-974-6539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1070 MONTGOMERY RD # 2247
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32714-7420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-974-6539
-----------------------------------------------------
Fax | 407-550-7174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN
-----------------------------------------------------
Name | MR. GABRIEL ALVAREZ
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 813-670-2649
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------