Organization
ELITE PSYCHIATRY SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN CLUKIE (ADMINISTRATOR)
(813) 997-2099
Entity
Organization
Contact information
Practice address
88 LOCHNAGAR MOUNTAIN DR, SAINT JOHNS, FL 32259-6672
(812) 870-8683
Mailing address
88 LOCHNAGAR MOUNTAIN DR, SAINT JOHNS, FL 32259-6672
(812) 870-8683
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/03/2022
Last updated
10/24/2023
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