Provider Demographics
NPI:1538572854
Name:CENTER OF REVITALIZING PSYCHIATRY PC
Entity type:Organization
Organization Name:CENTER OF REVITALIZING PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOURKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-677-3366
Mailing Address - Street 1:2033 WOOD ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7927
Mailing Address - Country:US
Mailing Address - Phone:941-677-3366
Mailing Address - Fax:941-677-3367
Practice Address - Street 1:2033 WOOD ST STE 220
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7927
Practice Address - Country:US
Practice Address - Phone:941-677-3366
Practice Address - Fax:941-677-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12-58-AD-4404-01261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGA166AMedicare PIN