Healthcare Provider Details

I. General information

NPI: 1629560545
Provider Name (Legal Business Name): UPSHAW TMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 GUNN HWY
TAMPA FL
33625-4021
US

IV. Provider business mailing address

6511 GUNN HWY
TAMPA FL
33625-4021
US

V. Phone/Fax

Practice location:
  • Phone: 813-731-5807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberME96275
License Number StateFL

VIII. Authorized Official

Name: MS. TAMI J BROCHMAN
Title or Position: DIR OF HR, COMPLIANCE & CORP ADMIN
Credential:
Phone: 813-605-1122