Healthcare Provider Details

I. General information

NPI: 1003674292
Provider Name (Legal Business Name): MAGNANIMITY RESOURCE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 W KENNEDY BLVD STE 100
TAMPA FL
33609-2457
US

IV. Provider business mailing address

5401 W KENNEDY BLVD STE 100
TAMPA FL
33609-2457
US

V. Phone/Fax

Practice location:
  • Phone: 813-317-1787
  • Fax: 813-762-1471
Mailing address:
  • Phone: 813-317-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA CLIPPS
Title or Position: PROVIDER
Credential: APRN, FNP-BC
Phone: 813-317-1787