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General NPI Number Information
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NPI Number | 1417657107
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Entity Type | Individual
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Provider Name | JESSICA LYNN TANCOS APRN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 5005 W LAUREL ST STE 205
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City | TAMPA
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State | FL
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Zip | 33607-3836
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Country | US
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Telephone | 813-922-1532
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Fax | 833-371-1901
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Provider Business Mailing Address
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Address Line | 5005 W LAUREL ST STE 205
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City | TAMPA
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State | FL
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Zip | 33607-3836
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Country | US
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Telephone | 813-922-1532
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Fax | 833-371-1901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9457938
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11025705
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License Number State | FL
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