| Cornerstone Psychiatric Care | |
|
13801 Bruce B Downs Blvd Ste 305 Tampa FL 33613-3939 | |
| (352) 519-2119 | |
| Not Available |
| Full Name | Cornerstone Psychiatric Care |
|---|---|
| Speciality | Family Medicine |
| Location | 13801 Bruce B Downs Blvd Ste 305, Tampa, Florida |
| Authorized Official Name and Position | Marc Ettensohn (CEO FOUNDER) |
| Authorized Official Contact | 3525192119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Psychiatric Care 13801 Bruce B Downs Blvd Ste 305 Tampa FL 33613-3939 Ph: (352) 519-2119 | Cornerstone Psychiatric Care 13801 Bruce B Downs Blvd Ste 305 Tampa FL 33613-3939 Ph: (352) 519-2119 |
| NPI Number | 1285256040 |
|---|---|
| Provider Enumeration Date | 05/14/2020 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/16/2024 |
| Medicare PECOS PAC ID | 7315369352 |
|---|---|
| Medicare Enrollment ID | O20200622001586 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285256040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Secondary |
| Provider Name | Diane Helen Esposito |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215251806 PECOS PAC ID: 6305975384 Enrollment ID: I20100601000433 |
| Provider Name | Marc Ettensohn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861753899 PECOS PAC ID: 9133355563 Enrollment ID: I20181110000181 |
| Provider Name | Brett Flanagan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629458419 PECOS PAC ID: 3779897103 Enrollment ID: I20190815002071 |
| Provider Name | Jaison Josekutty Nainaparampil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346621364 PECOS PAC ID: 3779890314 Enrollment ID: I20200626000695 |
| Provider Name | Jessica Ivy Shepley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700400140 PECOS PAC ID: 4284028614 Enrollment ID: I20220301002875 |
| Provider Name | Sophia Lynn Wong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962132597 PECOS PAC ID: 4981084969 Enrollment ID: I20220708000102 |
| Provider Name | Jessica Coote |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093395683 PECOS PAC ID: 3577922798 Enrollment ID: I20230706002953 |
| Provider Name | Christine Moffa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861016487 PECOS PAC ID: 8426473489 Enrollment ID: I20231114001224 |
| Provider Name | Nadine S Causey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760253991 PECOS PAC ID: 8022452804 Enrollment ID: I20240220003269 |
| Provider Name | Heather Stetson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578333233 PECOS PAC ID: 5496191918 Enrollment ID: I20240307000074 |
| Provider Name | Jodi Sandusky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700642584 PECOS PAC ID: 6608215595 Enrollment ID: I20240411001394 |
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