# TRANQUIL SHORES MENTAL WELLNESS LLC

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

## Provider details

- **NPI number:** 1790672277
- **Authorized official:** NICOLE ERVIN APRN (OWNER)
- **Authorized official phone:** (808) 400-6315

## Contact information

- **Practice address:** 120 KEAWE ST \# 203B, HILO, HI 96720-2874
- **Practice address phone:** (808) 400-6315
- **Practice address fax:** (808) 480-8344
- **Mailing address:** PO BOX 554, HILO, HI 96721-0554

## Taxonomy

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

## Other

- **Enumeration date:** 06/18/2025
- **Last updated:** 06/18/2025