Organization · Type 2 NPI

Mind Revive Psychiatry LLC

Nurse Practitioner · Lakeland, FL

NPI number 1285230185 Active

Practice location

4755 Drane Field Rd Ste 103
Lakeland, FL 33811-1259

Call (407) 602-3380 Map

Fax (833) 410-2620

Mailing address

4313 S Florida Ave # 1090
Lakeland, FL 33813-1654

Specialties and licenses

TaxonomyCodeLicense
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801XNone listed
Adolescent and Children Mental Health Clinic/Center 261QM0855XNone listed
Nurse Practitioner Primary 363L00000XNone listed

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1285230185

Mind Revive Psychiatry LLC's National Provider Identifier is 1285230185, issued on Dec 7, 2020. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Lakeland, FL. The record was last updated on Sep 24, 2026.