# LIVALITY INTEGRATED HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194507962
- **Authorized official:** DR. TYQUITTA PERRIER NP (CHIEF CLINICAL OFFICER/OWNER)
- **Authorized official phone:** (706) 289-2647

## Contact information

- **Practice address:** 1620 CORSAIR LN STE 201, MIDDLEBURG, FL 32068-8484
- **Practice address phone:** (904) 787-8850
- **Practice address fax:** (833) 740-3601
- **Mailing address:** 1075 OAKLEAF PLANTATION PKWY, SUITE 304, BOX 317, ORANGE PARK, FL 32065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2023
- **Last updated:** 10/17/2023