| Island Life Mental Health Llc | |
|
8253 113th St Seminole FL 33772-4128 | |
| (727) 295-5050 | |
| Not Available |
| Full Name | Island Life Mental Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8253 113th St, Seminole, Florida |
| Authorized Official Name and Position | Tracey Sanderbeck (PROVIDER) |
| Authorized Official Contact | 7272955050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Life Mental Health Llc 8253 113th St Seminole FL 33772-4128 Ph: (727) 295-5050 | Island Life Mental Health Llc 8253 113th St Seminole FL 33772-4128 Ph: (727) 295-5050 |
| NPI Number | 1881175925 |
|---|---|
| Provider Enumeration Date | 08/27/2018 |
| Last Update Date | 09/24/2018 |
| Medicare PECOS PAC ID | 7315281557 |
|---|---|
| Medicare Enrollment ID | O20181129000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881175925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tracey Ann Sanderbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104213719 PECOS PAC ID: 1052614930 Enrollment ID: I20160127001230 |
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