MEDICARE: HARBOR HOPE PSYCH CARE 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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1710724299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HOPE PSYCH CARE LLC

Provider Business Mailing Address
First Line	:	5400 S UNIVERSITY DR STE 407A
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-5311
Country	:	US
Telephone Number	:	954-448-7053
Fax Number	:	954-516-0649

Provider Business Practice Location Address
First Line	:	5400 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-5312
Country	:	US
Telephone Number	:	954-448-7053
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOLANDA CARDONA
Credential	:	PMHNP
Telephone Number	:	954-448-7053

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	05/26/2026

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