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NPI Code Detail

MEDICARE: IBIS HEALTHCARE INC

MEDICARE: IBIS HEALTHCARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1265383004
Entity Type Code : Organization
Provider Name (Legal Business Name) : IBIS HEALTHCARE INC
Provider Business Mailing Address
First Line : 5707 N 22ND ST
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4422 E COLUMBUS DR
Second Line :
City : TAMPA
State : FL
Zip : 33605-3233
Country : US
Telephone Number : 813-384-4216
Fax Number :
Authorized Official
Title or Position : CEO
Name : ROAYA TYSON
Credential :
Telephone Number : 813-239-8088
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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