MEDICARE: FLORIDA PSYCHIATRIC GROUP LLC

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	363LF0000X	Family Nurse Practitioner	ARNP9287498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750890455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PSYCHIATRIC GROUP LLC

Provider Business Mailing Address
First Line	:	11002 ANCIENT FUTURES DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3575
Country	:	US
Telephone Number	:	813-339-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	11002 ANCIENT FUTURES DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3575
Country	:	US
Telephone Number	:	813-820-3437
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHIRLEY J TABOR BEMLER
Credential	:	ARNP
Telephone Number	:	813-339-8106

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	09/25/2017

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