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General NPI Number Information
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NPI Number | 1841818952
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Entity Type | Organization
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Legal Business Name | SUNSHINE, LOLLIPOPS AND RAINBOWS, LLC
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 415 E MAIN ST STE 204
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City | BARTOW
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State | FL
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Zip | 33830-4703
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Country | US
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Telephone | 352-541-0485
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Fax | 813-566-0881
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Provider Business Mailing Address
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Address Line | 12428 HIDDEN BROOK DR
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City | TAMPA
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State | FL
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Zip | 33624-5725
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Country | US
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Telephone | 407-341-3883
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Fax | 813-566-0881
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JONATHAN DAVID POPE
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Credential | MSN AGPCNP PMHNP
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Telephone | 352-541-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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