Healthcare Provider Details

I. General information

NPI: 1215889852
Provider Name (Legal Business Name): ORTHOPAEDIC MEDICAL GROUP OF TAMPA BAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7239 PARADISO DR
APOLLO BEACH FL
33572
US

IV. Provider business mailing address

7239 PARADISO DR
APOLLO BEACH FL
33572
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-658-6222
Mailing address:
  • Phone: 813-684-2663
  • Fax: 813-658-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: TARYN REID
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 813-534-0102