Provider Demographics
NPI:1366231151
Name:MINDEASE PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:MINDEASE PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:FLUKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-305-9512
Mailing Address - Street 1:1802 MANSFIELD WEBB RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7810
Mailing Address - Country:US
Mailing Address - Phone:682-248-3233
Mailing Address - Fax:682-248-3233
Practice Address - Street 1:1802 MANSFIELD WEBB RD STE 106
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7810
Practice Address - Country:US
Practice Address - Phone:682-248-3233
Practice Address - Fax:682-248-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty