Provider Demographics
NPI:1306120456
Name:FLORIDA PSYCHIATRY ASSOCIATES LLC
Entity type:Organization
Organization Name:FLORIDA PSYCHIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANVLEET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-878-7216
Mailing Address - Street 1:260 NW PEACOCK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2349
Mailing Address - Country:US
Mailing Address - Phone:772-878-7216
Mailing Address - Fax:
Practice Address - Street 1:260 NW PEACOCK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2349
Practice Address - Country:US
Practice Address - Phone:772-878-7216
Practice Address - Fax:772-878-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty