Spartan Health Alliance LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SPARTAN HEALTH ALLIANCE LLC

Practice address

3040 N Wickham Rd Ste 3
Melbourne, FL 32935-2369

Phone

(321) 456-9653

Fax

(321) 204-9168

NPI assigned

Feb 7, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Harry W Carroll IV, APRN, FNP-C, PMHNP

Title

MGR

Phone

(954) 205-4551

Specialties & licenses 1

Addresses

Other names 1

• Suntree Psychiatry Doing business as

Locations

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1497409767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 N WICKHAM RD STE 3",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352369",
            "telephone_number": "321-456-9653",
            "fax_number": "321-204-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 N WICKHAM RD STE 3",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352369",
            "telephone_number": "321-456-9653",
            "fax_number": "321-204-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTAN HEALTH ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-07",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "HARRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "954-205-4551",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "APRN, FNP-C, PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suntree Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suntree Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lynette Spavin, MSW
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• Psychiatric/Mental Health Nurse Practitioner in Melbourne, FL
• Providers in Melbourne, 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 Aug 21, 2023; 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.