Healthcare Provider Details

I. General information

NPI: 1922942333
Provider Name (Legal Business Name): TAMPA NEUROPSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33920 US HIGHWAY 19 N STE 340
PALM HARBOR FL
34684-2670
US

IV. Provider business mailing address

PO BOX 306637
NASHVILLE TN
37230-6637
US

V. Phone/Fax

Practice location:
  • Phone: 813-995-1775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GLAVESKAS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 214-550-7536