MEDICARE: TAMPA BAY PSYCHIATRIC SERVICES PL

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
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME104526	FL
3	2084P0800X	Psychiatry Physician	ME104526	FL

General Provider Information

NPI Number	:	1245605468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY PSYCHIATRIC SERVICES PL

Provider Business Mailing Address
First Line	:	1767 LAKEWOOD RANCH BLVD
Second Line	:	NO. 255
City	:	BRADENTON
State	:	FL
Zip	:	34211-4906
Country	:	US
Telephone Number	:	183-699-4020
Fax Number	:	813-464-7682

Provider Business Practice Location Address
First Line	:	3848 FLATIRON LOOP
Second Line	:	SUITE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	813-699-4020
Fax Number	:	813-464-7682

Authorized Official
Title or Position	:	OFFICE MANAGER, CO-OWNER
Name	:	MRS. JOANNA WANDA GLUSZAK
Credential	:	MBA
Telephone Number	:	813-699-4020

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	05/26/2025

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