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General NPI Number Information
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NPI Number | 1942143615
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Entity Type | Organization
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Legal Business Name | INTEGRATED MIND & MEDRX MGT. INC
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 2300 NW 22ND ST STE 119
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-2937
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Country | US
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Telephone | 954-997-0863
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Fax | 833-485-4283
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Provider Business Mailing Address
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Address Line | 2300 NW 22ND ST STE 119
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-2937
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Country | US
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Telephone | 954-609-4815
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDREA WILLOUGHBY TAYLOR
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Credential | PMHNP
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Telephone | 954-997-0863
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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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