MEDICARE: PRIVATE PSYCHIATRY OF SOUTH WEST FLORIDA. INC

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	ARNP9276826	FL

General Provider Information

NPI Number	:	1811432610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVATE PSYCHIATRY OF SOUTH WEST FLORIDA. INC

Provider Business Mailing Address
First Line	:	5454 LENA RD
Second Line	:	SUITE 106
City	:	BRADENTON
State	:	FL
Zip	:	34211-9499
Country	:	US
Telephone Number	:	941-900-1111
Fax Number	:	941-201-4856

Provider Business Practice Location Address
First Line	:	5454 LENA RD
Second Line	:	SUITE 106
City	:	BRADENTON
State	:	FL
Zip	:	34211-9499
Country	:	US
Telephone Number	:	941-900-1111
Fax Number	:	941-201-4856

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN CASE
Credential	:
Telephone Number	:	941-900-1111

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	03/23/2017

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