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General NPI Number Information
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NPI Number | 1801616248
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Entity Type | Organization
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Legal Business Name | TRANQUIL MINDA MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 154 E BROADWAY ST STE 2
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City | MONTICELLO
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State | MN
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Zip | 55362-8944
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Country | US
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Telephone | 612-429-8280
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Fax | 855-239-8566
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Provider Business Mailing Address
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Address Line | 154 E BROADWAY ST STE 2
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City | MONTICELLO
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State | MN
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Zip | 55362-8944
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Country | US
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Telephone | 612-429-8280
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Fax | 855-239-8566
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Authorized Official
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Title or Position | PROVIDER
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Name | ROXANNE JO DOBRAVA
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Credential | PMHNP-BC
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Telephone | 612-429-7338
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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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