Healthcare Provider Details

I. General information

NPI: 1932759149
Provider Name (Legal Business Name): IBIS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 N 22ND STREET
TAMPA FL
33610-4350
US

IV. Provider business mailing address

5707 N 22ND ST
TAMPA FL
33610-4350
US

V. Phone/Fax

Practice location:
  • Phone: 813-239-8069
  • Fax: 813-231-7324
Mailing address:
  • Phone: 813-239-8069
  • Fax: 813-231-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROAYA TYSON
Title or Position: CEO
Credential:
Phone: 813-239-8088