Healthcare Provider Details

I. General information

NPI: 1164754701
Provider Name (Legal Business Name): TAMPA FAMILY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7814 N DALE MABRY HWY
TAMPA FL
33614-3220
US

IV. Provider business mailing address

PO BOX 82969
TAMPA FL
33682-2969
US

V. Phone/Fax

Practice location:
  • Phone: 813-866-0930
  • Fax: 813-866-0929
Mailing address:
  • Phone: 813-866-0930
  • Fax: 813-866-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY M PAGAN
Title or Position: VP, REVENUE CYCLE MANAGEMENT
Credential:
Phone: 813-730-3268