MEDICARE: MAGNA HEALTH RESOURCE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	364SW0102X	Women's Health Clinical Nurse Specialist
2	163WC1500X	Community Health Registered Nurse
3	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1396678009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNA HEALTH RESOURCE INC

Provider Business Mailing Address
First Line	:	6484 LAUREL OAK DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34607-2321
Country	:	US
Telephone Number	:	813-846-7582
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 W KENNEDY BLVD # 166
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2428
Country	:	US
Telephone Number	:	813-317-1787
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ERICA HARVETTE CLIPPS
Credential	:	APRN
Telephone Number	:	813-846-7582

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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