Provider Demographics
NPI:1609611383
Name:EXPRESS PSYCH CARE INC
Entity type:Organization
Organization Name:EXPRESS PSYCH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:863-225-2355
Mailing Address - Street 1:5112 SUMMER BROOKE LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2679
Mailing Address - Country:US
Mailing Address - Phone:863-225-2355
Mailing Address - Fax:863-225-4401
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:863-225-2355
Practice Address - Fax:863-225-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health