MEDICARE: SERENITY PSYCHIATRY GROUP INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician
4	363LF0000X	Family Nurse Practitioner
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
6	363LP2300X	Primary Care Nurse Practitioner
7	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1033972047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY PSYCHIATRY GROUP INCORPORATED

Provider Business Mailing Address
First Line	:	14518 CHERRY LAKE DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5140
Country	:	US
Telephone Number	:	904-200-8978
Fax Number	:	904-644-5443

Provider Business Practice Location Address
First Line	:	14518 CHERRY LAKE DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5140
Country	:	US
Telephone Number	:	904-200-8978
Fax Number	:	904-644-5443

Authorized Official
Title or Position	:	PMHNP, FNP - BC
Name	:	LATARA TAYLOR
Credential	:	PMHNP, FNP - BC
Telephone Number	:	904-200-8978

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “SERENITY PSYCHIATRY GROUP INCORPORATED ” Practice Location

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