Revitalize Mental Health & Integrative Medicine LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

REVITALIZE MENTAL HEALTH & INTEGRATIVE MEDICINE LLC

Practice address

8225 State Road 54
Trinity, FL 34655-3016

Phone

(727) 242-8800

NPI assigned

Dec 10, 2024

Organization subpart

No

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

Authorized official

Name

Michelle Lee Thomas, APRN, PMHNPNPI 1700323748

Title

Owner

Phone

(734) 558-3401

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michelle Thomas, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Dunedin, FL
  • NPI 1700323748
  NPD Authorized official

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

{
    "created_epoch": "1733788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1306652607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 OHIO AVE",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346984514",
            "telephone_number": "734-558-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8225 STATE ROAD 54",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346553016",
            "telephone_number": "727-242-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE MENTAL HEALTH & INTEGRATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-10",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-558-3401",
        "authorized_official_credential": "APRN, PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vamsi Priyatham Reddy Mallu, MD
• Trisha Ann Reed, RN
• Robyn Mara Reese, APRN, CNM
• Paul A Rentz, ARNP,
• Nicole Goldowski Richa, AUD
• Richard N Maravel MD PA
• Michelina Elizabeth Richardson Baker, PT, DPT
• Katherine Robinson Riehl, MS, ARNP-BC
• Yousef Rifai

• Psychiatric/Mental Health Nurse Practitioner in Trinity, FL
• Providers in Trinity, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.