MEDICARE: JUST PSYCH 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1528706991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST PSYCH LLC

Provider Business Mailing Address
First Line	:	110 ATHENS STREET
Second Line	:	STE O
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3304
Country	:	US
Telephone Number	:	727-249-4898
Fax Number	:	727-295-1648

Provider Business Practice Location Address
First Line	:	110 ATHENS STREET
Second Line	:	STE O
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3304
Country	:	US
Telephone Number	:	727-249-4898
Fax Number	:	727-295-1648

Authorized Official
Title or Position	:	MEMBER
Name	:	SANDRA L RISOLDI
Credential	:	PMHNP
Telephone Number	:	727-249-4898

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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