Provider Demographics
NPI:1891150488
Name:TAMPA BAY PSYCHIATRIC SERVICES PL
Entity type:Organization
Organization Name:TAMPA BAY PSYCHIATRIC SERVICES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:WANDA
Authorized Official - Last Name:GLUSZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-699-4020
Mailing Address - Street 1:1767 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:NO. 255
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4906
Mailing Address - Country:US
Mailing Address - Phone:941-527-0159
Mailing Address - Fax:813-464-7682
Practice Address - Street 1:5664 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3331
Practice Address - Country:US
Practice Address - Phone:941-527-0159
Practice Address - Fax:813-464-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1045262084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty