Provider Demographics
NPI:1396548921
Name:SUBLIME MIND
Entity type:Organization
Organization Name:SUBLIME MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBROKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-371-7292
Mailing Address - Street 1:104 MARINERS CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-5630
Mailing Address - Country:US
Mailing Address - Phone:757-280-4801
Mailing Address - Fax:757-767-7866
Practice Address - Street 1:911 FIRST COLONIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3111
Practice Address - Country:US
Practice Address - Phone:757-280-4801
Practice Address - Fax:757-767-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-29
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty