MEDICARE: INTERVENTIONALPSYCHIATRY OF TAMPA BAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93153	OTHER		FLORIDA

General Provider Information

NPI Number	:	1013677855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONALPSYCHIATRY OF TAMPA BAY

Provider Business Mailing Address
First Line	:	1001 S MACDILL AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5245
Country	:	US
Telephone Number	:	813-251-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S MACDILL AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5245
Country	:	US
Telephone Number	:	813-251-1800
Fax Number	:	813-251-9422

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMIE WINDERBAUM FERNANDEZ
Credential	:	MD
Telephone Number	:	813-251-1800

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	12/21/2021

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