Provider Demographics
NPI:1730224403
Name:TARPON PSYCHIATRIC CENTER, P.A.
Entity type:Organization
Organization Name:TARPON PSYCHIATRIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:NICKOLAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-938-0714
Mailing Address - Street 1:1501 S PINELLAS AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-1955
Mailing Address - Country:US
Mailing Address - Phone:727-938-0714
Mailing Address - Fax:727-938-9513
Practice Address - Street 1:1501 S PINELLAS AVE
Practice Address - Street 2:SUITE K
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1955
Practice Address - Country:US
Practice Address - Phone:727-938-0714
Practice Address - Fax:727-938-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00558772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7304Medicare ID - Type Unspecified
FLE84316Medicare UPIN