Organization
SUNNYSIDE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY TIBBETTS APRN (OWNER)
(813) 298-9305
Entity
Organization
Contact information
Practice address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(813) 508-8187
Mailing address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(813) 508-8187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/13/2023
Last updated
01/16/2024
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