Healthcare Provider Details

I. General information

NPI: 1144924754
Provider Name (Legal Business Name): NORTH TAMPA EXECUTIVE HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FLETCHER AVE STE 201
TAMPA FL
33613-4795
US

IV. Provider business mailing address

1204 S BROAD ST # 192
BROOKSVILLE FL
34601-3132
US

V. Phone/Fax

Practice location:
  • Phone: 813-753-8836
  • Fax:
Mailing address:
  • Phone: 352-410-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK MCGEACHY
Title or Position: MANAGER
Credential: MD
Phone: 813-997-7942