Organization
BLUE WAVE PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELIX WIDLACKI DO (CEO)
(727) 871-1178
Entity
Organization
Contact information
Practice address
6601 MEMORIAL HWY, TAMPA, FL 33615-4501
(727) 871-1178
Mailing address
6601 MEMORIAL HWY, TAMPA, FL 33615-4501
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OS11223
FL
Other
Enumeration date
09/12/2013
Last updated
09/01/2020
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