Healthcare Provider Details

I. General information

NPI: 1922254747
Provider Name (Legal Business Name): DUELLYN Z. PANDIS DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/13/2021
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4204 W LINEBAUGH AVE
TAMPA FL
33624-5241
US

IV. Provider business mailing address

4204 W LINEBAUGH AVE
TAMPA FL
33624-5241
US

V. Phone/Fax

Practice location:
  • Phone: 813-969-3757
  • Fax:
Mailing address:
  • Phone: 813-969-3757
  • Fax: 813-969-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2855132
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN2855132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2855132
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberARNP2855132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: