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1300 N West Shore Blvd Ste 240 Tampa FL 33607-4629 | |
| (813) 636-8300 | |
| (813) 636-8301 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1300 N West Shore Blvd Ste 240, Tampa, Florida |
| Authorized Official Name and Position | Eric L Weinstock (PRESIDENT) |
| Authorized Official Contact | 8136368300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1300 N West Shore Blvd Ste 240 Tampa FL 33607-4629 Ph: (813) 636-8300 | 1300 N West Shore Blvd Ste 240 Tampa FL 33607-4629 Ph: (813) 636-8300 |
| NPI Number | 1386814481 |
|---|---|
| Provider Enumeration Date | 03/04/2008 |
| Last Update Date | 11/17/2024 |
| Certification Date | 10/31/2024 |
| Medicare PECOS PAC ID | 0143309922 |
|---|---|
| Medicare Enrollment ID | O20080505000709 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386814481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME93332 (Florida) | Primary |
| Provider Name | Eric Weinstock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679554687 PECOS PAC ID: 7315978376 Enrollment ID: I20050830000193 |
| Provider Name | Mary K Parham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407980568 PECOS PAC ID: 8820160732 Enrollment ID: I20080710000175 |
| Provider Name | Amanda R Costello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346678026 PECOS PAC ID: 1254567175 Enrollment ID: I20151112001994 |
| Provider Name | Jonathan D Pope |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912407628 PECOS PAC ID: 8426302571 Enrollment ID: I20181108002377 |
| Provider Name | Jade Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447771787 PECOS PAC ID: 4880965912 Enrollment ID: I20201020002481 |
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