Traumatic Brain Diagnostic, LLC

Primary specialty

Brain Injury Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P0301X

Legal business name

TRAUMATIC BRAIN DIAGNOSTIC, LLC

Practice address

1814 Wellness LN
Trinity, FL 34655-5357

Phone

(813) 450-8989

NPI assigned

Jun 11, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Caroline Adams

Title

Account Administrator

Phone

(727) 203-1023

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1003431396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 WELLNESS LN",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346555357",
            "telephone_number": "813-450-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 WELLNESS LN",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346555357",
            "telephone_number": "813-450-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAUMATIC BRAIN DIAGNOSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "ACCOUNT ADMINISTRATOR",
        "authorized_official_telephone_number": "727-203-1023",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0301X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brain Injury Medicine (Psychiatry & Neurology) Physician in Trinity, FL
• Providers in Trinity, FL by specialty
• Brain Injury Medicine (Psychiatry & Neurology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.