MEDICARE: TAMPA FAMILY HEALTH CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1194392019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA FAMILY HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 82969
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33682-2969
Country	:	US
Telephone Number	:	813-397-5300
Fax Number	:	813-405-3722

Provider Business Practice Location Address
First Line	:	1212 E BEARS AVE
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-0000
Country	:	US
Telephone Number	:	813-397-5300
Fax Number	:

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE MANAGEMENT
Name	:	STACY PAGAN
Credential	:
Telephone Number	:	813-730-3268

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/11/2026

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