MEDICARE: PASSPORT HEALTH OF TAMPA BAY

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	261QH0100X	Health Service Clinic/Center	RN2855132	FL

General Provider Information

NPI Number	:	1932356052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSPORT HEALTH OF TAMPA BAY

Provider Business Mailing Address
First Line	:	4202 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-969-3757
Fax Number	:	813-969-3052

Provider Business Practice Location Address
First Line	:	4202 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-969-3757
Fax Number	:	813-969-3052

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DUELLYN Z. PANDIS
Credential	:	DNP, APRN, FNP-C
Telephone Number	:	813-969-3757

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	06/03/2026

Similar Medicare Providers

1922254747 — DR. DUELLYN Z. PANDIS DNP, APRN, FNP-C
Practice Location Address:

4204 W LINEBAUGH AVE
TAMPA, FL
33624-5241

Practice Phone: 813-969-3757
Practice Fax:

1306450085 — AZIMUTH HEALTH, LLC
Practice Location Address:

4204 W LINEBAUGH AVE
TAMPA, FL
33624-5241

Practice Phone: 813-940-8855
Practice Fax:

1699968909 — PASSPORT HEALTH OF TAMPA BAY
Practice Location Address:

4202 W LINEBAUGH AVE
TAMPA, FL
33624-5241

Practice Phone: 813-969-3757
Practice Fax:

1033114509 — DR. REYNALDO F MULINGTAPANG M.D.
Practice Location Address:

4210 W LINEBAUGH AVE
TAMPA, FL
33624-5241

Practice Phone: 813-884-0923
Practice Fax: 813-377-1006

1629074596 — DR. INDI VASUDEVA M.D.
Practice Location Address:

4218 W LINEBAUGH AVE
TAMPA, FL
33624-5241

Practice Phone: 813-961-6633
Practice Fax: 813-961-7733

1326006081 — MICHAEL A CROMER M.D.
Practice Location Address:

4278 W LINEBAUGH AVE , SUITE B
TAMPA, FL
33624-5241

Practice Phone: 813-960-3321
Practice Fax: 813-264-7532

Directions to “PASSPORT HEALTH OF TAMPA BAY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.