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12512 Bruce B Downs Blvd Tampa FL 33612 | |
| (813) 977-8700 | |
| (813) 971-2029 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 12512 Bruce B Downs Blvd, Tampa, Florida |
| Authorized Official Name and Position | Lynda Gorken (VICE PRESIDENT) |
| Authorized Official Contact | 7272819202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2995 Drew St Fl 2 Clearwater FL 33759-3012 Ph: (727) 315-6974 | 12512 Bruce B Downs Blvd Tampa FL 33612 Ph: (813) 977-8700 |
| NPI Number | 1669498002 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 08/01/2023 |
| Certification Date | 08/01/2023 |
| Medicare PECOS PAC ID | 9931187911 |
|---|---|
| Medicare Enrollment ID | O20040708000284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669498002 | NPI | - | NPPES |
| 117042300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Steven N Kanfer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740337039 PECOS PAC ID: 1254322605 Enrollment ID: I20040524000435 |
| Provider Name | Randall D Cobb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750314605 PECOS PAC ID: 5890746358 Enrollment ID: I20050202000643 |
| Provider Name | Nirmala Apte |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740387463 PECOS PAC ID: 5597748418 Enrollment ID: I20060228000535 |
| Provider Name | Quamrul H Chowdhury |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386741007 PECOS PAC ID: 2668481532 Enrollment ID: I20060420000581 |
| Provider Name | Ashok K Komarla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790882439 PECOS PAC ID: 8123192325 Enrollment ID: I20080806000507 |
| Provider Name | Neil A Thierry |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548271596 PECOS PAC ID: 0648335802 Enrollment ID: I20090223000337 |
| Provider Name | Luis C Gutierrez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801882022 PECOS PAC ID: 9739376419 Enrollment ID: I20101207000654 |
| Provider Name | Luis A Franco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720048812 PECOS PAC ID: 3173552981 Enrollment ID: I20140210000118 |
| Provider Name | Vilas Patil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417044983 PECOS PAC ID: 2668489089 Enrollment ID: I20210407002871 |
| Provider Name | Dawit Amare |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992959555 PECOS PAC ID: 5395916001 Enrollment ID: I20210819000467 |
| Provider Name | Robert Paul Blessin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801388657 PECOS PAC ID: 5395124234 Enrollment ID: I20220623000035 |
| Provider Name | Alvaro Jorge Gonzalez Alfonzo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619405891 PECOS PAC ID: 0345589651 Enrollment ID: I20220629003666 |
| Provider Name | Andrew Chu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154826188 PECOS PAC ID: 8820478183 Enrollment ID: I20220704000131 |
| Provider Name | Charisse T Reid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679113906 PECOS PAC ID: 7911364963 Enrollment ID: I20230606002653 |
| Provider Name | Michael D'agosta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962963785 PECOS PAC ID: 1153657655 Enrollment ID: I20230818000120 |
| Provider Name | Karla Daniela Calzada Morales |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013368349 PECOS PAC ID: 7315204096 Enrollment ID: I20230831001256 |
| Provider Name | Savannah Sterns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205327558 PECOS PAC ID: 4688023641 Enrollment ID: I20231215001892 |
| Provider Name | Zoila Rey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386904282 PECOS PAC ID: 9335598309 Enrollment ID: I20231215002265 |
| Provider Name | Eric R Brotherton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114349933 PECOS PAC ID: 6507215407 Enrollment ID: I20231216000383 |
| Provider Name | George Tadros |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427775832 PECOS PAC ID: 0840640645 Enrollment ID: I20231220000246 |
| Provider Name | Briana Counihan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992572713 PECOS PAC ID: 2961853411 Enrollment ID: I20240109001781 |
| Provider Name | Deborah Panariello |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356634588 PECOS PAC ID: 7911358247 Enrollment ID: I20240110004415 |
| Provider Name | Audra Colleen Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578801726 PECOS PAC ID: 0547611808 Enrollment ID: I20240110005256 |
| Provider Name | Megan M Holmes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750722369 PECOS PAC ID: 7214371848 Enrollment ID: I20240222000113 |
| Provider Name | Aleida Esabel Hernandez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275744518 PECOS PAC ID: 5294174017 Enrollment ID: I20240412002314 |
| Provider Name | Onisha M Sutherland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740007210 PECOS PAC ID: 5092247452 Enrollment ID: I20241010002387 |
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