MEDICARE: TRANQUILITY MENTAL HEALTH PA

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	:	1295690634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY MENTAL HEALTH PA

Provider Business Mailing Address
First Line	:	105 S RIVERSIDE DR STE 151
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-327-4606
Fax Number	:	321-327-3278

Provider Business Practice Location Address
First Line	:	105 S RIVERSIDE DR STE 151
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-4321
Country	:	US
Telephone Number	:	321-327-4606
Fax Number	:	321-327-3278

Authorized Official
Title or Position	:	CEO
Name	:	RYAN C MYERS
Credential	:	APRN
Telephone Number	:	865-246-8508

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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