MEDICARE: BRIDGEPOINT PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1053253948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEPOINT PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	4853 E IRLO BRONSON MEMORIAL HWY # 1047
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-8722
Country	:	US
Telephone Number	:	689-334-2569
Fax Number	:	321-513-0655

Provider Business Practice Location Address
First Line	:	4657 GLENCREST LOOP
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-9015
Country	:	US
Telephone Number	:	407-801-9051
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ZAKIA FREDERICK
Credential	:	APRN
Telephone Number	:	689-334-2569

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	06/18/2026

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