Organization
PSYCHIATRIC ASSOCIATES. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANAH W LARSON RN (SECRETARY, PRACTICE ADMINISTRATOR)
(904) 264-6977
Entity
Organization
Contact information
Practice address
1543 KINGSLEY AVE STE 14, ORANGE PARK, FL 32073-4570
(904) 264-6977
(904) 269-0870
Mailing address
1543 KINGSLEY AVE STE 14, ORANGE PARK, FL 32073-4570
(904) 264-6977
(904) 269-0870
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25939900
—
FL
Enumeration date
08/08/2014
Last updated
08/08/2014
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