Healthcare Provider Details

I. General information

NPI: 1982360244
Provider Name (Legal Business Name): PP-FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
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: 813-969-3052
Mailing address:
  • Phone: 813-969-3757
  • Fax: 813-969-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DUELLYN PANDIS
Title or Position: EXECUTIVE DIRECTOR
Credential: ARNP
Phone: 813-969-3757