RYAN COLT WAGONER (NPI# 1952531204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952531204 |
| Entity Type | Individual |
| Full Name | RYAN COLT WAGONER |
| Credential | M.D. |
| Practice Address |
3515 E Fletcher Ave Mdc 14 Tampa FL 33613-4702 |
| Mailing Address |
Po Box 917770 Orlando FL 32891-7770 |
| Practice Telephone | 8139748900 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2016-03-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
A124075 | CA | Allopathic & Osteopathic Physicians |
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
ME119037 | FL | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
71582 | GA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | MT194511 | PA | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 1510A | 01 |
| FL | 015294500 | 05 |
| Street Address |
3515 E FLETCHER AVE MDC 14 |
| City | TAMPA |
| State | FL |
| Zip Code | 33613-4702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508856261 | David Newman | Physical Therapist | 3515 E Fletcher Ave, Mdc 90, Tampa, FL 33613-4706 | 2005-10-25 |
| 1932746328 | Kimberly Ann Knap | Psychologist | 3515 E Fletcher Ave, Tampa, FL 33613-4706 | 2019-12-04 |
| 1932624194 | Karie Suzanne John | Behavior Technician | 3515 E Fletcher Ave, Tampa, FL 33613-4706 | 2017-08-09 |
| 1164974366 | University Medical Service Association Inc | Assistant Behavior Analyst | 3515 E Fletcher Ave, Tampa, FL 33613-4706 | 2016-11-04 |
| 1801214002 | Grace Hyeiwon Lee | Psychiatry & Neurology | 3515 E Fletcher Ave, Tampa, FL 33613 | 2014-04-03 |
| 1528492857 | Brian E Bunnell | Psychologist | 3515 E Fletcher Ave, Tampa, FL 33613-4706 | 2013-08-22 |
| 1104168855 | Christina Mary Martin | Psychiatry & Neurology | 3515 E Fletcher Ave, Tampa, FL 33613-4706 | 2013-03-20 |
| 1467707059 | Amanda Lynn Walker | Social Worker | 3515 E Fletcher Ave, Mdc 14, Tampa, FL 33613-4702 | 2012-07-19 |
| 1043598014 | Brittany Dawn Zern | Psychologist | 3515 E Fletcher Ave, Mdc 14, Tampa, FL 33613-4702 | 2011-07-25 |
| 1861789521 | Thea Rosanna Moore | Pharmacist | 3515 E Fletcher Ave, Tampa, FL 33613-4702 | 2011-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649877671 | Lisandra Isabelle Raba | Behavior Technician | 3299 Usf Banyan Circle, Tampa, FL 33613 | 2020-10-02 |
| 1184250490 | Stetho Md LLC | Family Medicine | 1707 E Bearss Ave, Tampa, FL 33613 | 2020-03-18 |
| 1174187645 | Renee Pinheiro | Student in an Organized Health Care Education/Training Program | Usf Health Morsani College of Medicine, 12901 Bruce B Downs Blvd. Mdc5, Tampa, FL 33613 | 2019-04-30 |
| 1104388842 | Heartbeat Home Health Care LLC | Home Health | 13542 N Florida Ave Ste 209-b, Tampa, FL 33613 | 2019-04-02 |
| 1437625357 | Carierx LLC | Pharmacy | 15511 N. Florida Avenue, Ste 601, Tampa, FL 33613 | 2018-10-18 |
| 1205312980 | Sabina Vlaeva | Dentist | Affordable Dentures & Implants, 14936 N Florida Avenue Ste 101, Tampa, FL 33613 | 2018-07-16 |
| 1780170266 | Joy M. Alexander | Driver | 14209 Cyber Pl Apt 102, Tampa, FL 33613 | 2018-07-08 |
| 1598289829 | Lillian Perez | Social Worker | 13542 N Florida Avenue, Suite 210, Tampa, FL 33613 | 2017-07-28 |
| 1134640386 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3100 E Fletcher Ave Ste A165, Tampa, FL 33613 | 2017-06-28 |
| 1770016099 | Marcus Bruno | Physician Assistant | 13701 Bruce B Downs Blvd., Tampa, FL 33613 | 2017-04-04 |
| Find all providers in zip 33613 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043776859 | Ann Park | Psychiatry & Neurology | 1002b S Church Ave # 320056, Tampa, FL 33629-5018 | 2019-02-17 |
| 1730652645 | South Tampa Psychiatry | Psychiatry & Neurology | 2919 W Swann Ave Ste 104, Tampa, FL 33609-4049 | 2019-01-03 |
| 1902393069 | Tampa Bay Center for Psychological Health | Psychiatry & Neurology | 14924 Casey Rd Unit 3b, Tampa, FL 33624-2317 | 2018-04-15 |
| 1508222324 | Behavioral Health Science of West Florida, LLC | Psychiatry & Neurology | 508 S Habana Ave Ste 380, Tampa, FL 33609-4144 | 2016-01-08 |
| 1912249228 | Scott Edward Nelson | Psychiatry & Neurology | 3515 E Fletcher Ave # 14, Tampa, FL 33613 | 2013-03-25 |
| 1649533787 | Sumaira Fayyaz Khan Md LLC | Psychiatry & Neurology | 18022 Cozumel Isle Dr, Tampa, FL 33647-3373 | 2012-06-22 |
| 1225355340 | Chetan P Gandhy | Psychiatry & Neurology | 13330 Usf Laurel Dr., Tampa, FL 33612-4742 | 2010-04-29 |
| 1396060174 | Shirrin Ahmadi-davis | Psychiatry & Neurology | 2727 W Mlk Blvd, Suite 640, Tampa, FL 33607-6383 | 2010-04-05 |
| 1104141423 | Pragneshkumar P Patel | Psychiatry & Neurology | 613 W Dr Martin Luther King Jr Blvd Ste 102, Tampa, FL 33603-3400 | 2010-03-30 |
| 1497081624 | Nancy Dinwoodie | Psychiatry & Neurology | 3515 Heards Ferry Dr, Tampa, FL 33618-2922 | 2009-10-22 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.