=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982403630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUIL LIFE PSYCHIATRIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 CHURCH ST
-----------------------------------------------------
City | BLACKSTONE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23824-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-218-4353
-----------------------------------------------------
Fax | 434-218-4393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1932 PIEDMONT RD
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23435-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH HOLSHOE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 434-218-4353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------