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General NPI Number Information
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NPI Number | 1770976698
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Entity Type | Organization
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Legal Business Name | GROWING MIND HEALTH AND WELLNESS
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 9340 MUSTARD LEAF DR
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City | ORLANDO
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State | FL
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Zip | 32827-7082
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Country | US
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Telephone | 407-489-0426
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Fax | 407-210-6838
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Provider Business Mailing Address
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Address Line | 7901 KINGSPOINTE PKWY SUITE 19
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City | ORLANDO
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State | FL
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Zip | 32819-6520
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Country | US
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Telephone | 407-489-0426
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Fax | 407-210-6838
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Authorized Official
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Title or Position | ARNP
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Name | CHERYL H GARDNER
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Credential | NP
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Telephone | 407-489-0426
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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 | ARNP9214022
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License Number State | FL
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