MEDICARE: HEALTH ASSOCIATES OF TAMPA BAY PA

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	207R00000X	Internal Medicine Physician	ME107704	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME112619	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295007789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH ASSOCIATES OF TAMPA BAY PA

Provider Business Mailing Address
First Line	:	508 S HABANA AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4144
Country	:	US
Telephone Number	:	813-877-6770
Fax Number	:	813-877-6771

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4144
Country	:	US
Telephone Number	:	813-877-6770
Fax Number	:	813-877-6771

Authorized Official
Title or Position	:	BILLING
Name	:	BRIAN CLUKIE
Credential	:
Telephone Number	:	813-997-2099

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	06/12/2026

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