| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6511 Gunn Hwy, Tampa, Florida |
| Authorized Official Name and Position | Tami J Brochman (DIR OF HR, COMPLIANCE & CORP ADMIN) |
| Authorized Official Contact | 8136051122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6511 Gunn Hwy Tampa FL 33625-4021 Ph: () - | 6511 Gunn Hwy Tampa FL 33625-4021 Ph: (813) 731-5807 |
| NPI Number | 1629560545 |
|---|---|
| Provider Enumeration Date | 06/06/2018 |
| Last Update Date | 10/02/2024 |
| Certification Date | 10/02/2024 |
| Medicare PECOS PAC ID | 3678819349 |
|---|---|
| Medicare Enrollment ID | O20190117000340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629560545 | NPI | - | NPPES |
| ME96275 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | ME96275 (Florida) | Secondary |
| Provider Name | William N Upshaw |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932276425 PECOS PAC ID: 0648317719 Enrollment ID: I20091021000718 |
| Provider Name | Demian F Obregon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801058250 PECOS PAC ID: 7911174594 Enrollment ID: I20140512000907 |
| Provider Name | Derek L Robben |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003078460 PECOS PAC ID: 1951564764 Enrollment ID: I20200818001487 |
| Provider Name | Elle Essman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366928335 PECOS PAC ID: 3577967090 Enrollment ID: I20210805002136 |
| Provider Name | Sharon Gordon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568116986 PECOS PAC ID: 9739574385 Enrollment ID: I20220316004075 |
| Provider Name | Jill Michelle Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144810235 PECOS PAC ID: 0042691222 Enrollment ID: I20220719002892 |
| Provider Name | Bryan F Espinet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285310599 PECOS PAC ID: 2567824352 Enrollment ID: I20230810002020 |
| Provider Name | Emily R Adams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053858886 PECOS PAC ID: 4688020852 Enrollment ID: I20231024002184 |
| Provider Name | Panagiota Marie Markopoulos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649997701 PECOS PAC ID: 5193173839 Enrollment ID: I20231120000122 |
| Provider Name | Alexandra Nicole Bithorn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184172827 PECOS PAC ID: 8527416098 Enrollment ID: I20231121002675 |
| Provider Name | Aleia Lorraine Tierney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740718501 PECOS PAC ID: 9032567110 Enrollment ID: I20231130000060 |
| Provider Name | Shera Sue Klotz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306101555 PECOS PAC ID: 0345698379 Enrollment ID: I20231130002441 |
| Provider Name | Kathryn Lynn Moynihan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366219222 PECOS PAC ID: 9537501523 Enrollment ID: I20240522001367 |
| Provider Name | Jenna M Petrella |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790517670 PECOS PAC ID: 9335680214 Enrollment ID: I20240918003838 |
| Provider Name | Katelyn M Bowers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508692336 PECOS PAC ID: 1355875253 Enrollment ID: I20241114003712 |
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