Provider Demographics
NPI:1689487639
Name:MINDFUL OVER MATTER PSYCHIATRY & WELLNESS
Entity type:Organization
Organization Name:MINDFUL OVER MATTER PSYCHIATRY & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP
Authorized Official - Phone:561-814-8143
Mailing Address - Street 1:11017 MULBERRY GARDEN TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-5091
Mailing Address - Country:US
Mailing Address - Phone:480-207-8627
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9476
Practice Address - Country:US
Practice Address - Phone:561-814-8143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty