Provider Demographics
NPI:1316509185
Name:HEALTHY MINDS & HEALING HEARTS
Entity type:Organization
Organization Name:HEALTHY MINDS & HEALING HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-300-0987
Mailing Address - Street 1:843 VISCOUNT ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6653
Mailing Address - Country:US
Mailing Address - Phone:813-300-0987
Mailing Address - Fax:
Practice Address - Street 1:843 VISCOUNT ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6653
Practice Address - Country:US
Practice Address - Phone:813-300-0987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty