Blue Wave Psychiatry LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OS11223 Issued in FL

Legal business name

BLUE WAVE PSYCHIATRY LLC

Practice address

6601 Memorial Hwy
Tampa, FL 33615-4501

Phone

(727) 871-1178

NPI assigned

Sep 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Felix Widlacki, DO

Title

Ceo

Phone

(727) 871-1178

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1164857876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 MEMORIAL HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336154501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 MEMORIAL HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336154501",
            "telephone_number": "727-871-1178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-12",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "WIDLACKI",
        "authorized_official_first_name": "FELIX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "727-871-1178",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS11223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.