Provider Demographics
NPI:1013677855
Name:INTERVENTIONALPSYCHIATRY OF TAMPA BAY
Entity type:Organization
Organization Name:INTERVENTIONALPSYCHIATRY OF TAMPA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:WINDERBAUM
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-251-1800
Mailing Address - Street 1:1001 S MACDILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5245
Mailing Address - Country:US
Mailing Address - Phone:813-251-1800
Mailing Address - Fax:
Practice Address - Street 1:1001 S MACDILL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5245
Practice Address - Country:US
Practice Address - Phone:813-251-1800
Practice Address - Fax:813-251-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
93153OtherFLORIDA