Individual provider Active NPI

Tia Marie Haas, APRN

  • Acute Care Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1033872767
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
APRN11016094 Issued in FL
Practice address
17 Davis Blvd Ste 402
Tampa, FL 33606-3438
Phone
(813) 821-8008
Fax
(813) 821-8355
NPI assigned
Oct 19, 2021
Last updated
Mar 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X APRN11016094 FL Primary

Addresses

Primary practice location

17 Davis Blvd Ste 402
Tampa, FL 33606-3438

Mailing address

PO Box 917770
Orlando, FL 32891-0001

Other practice location 1

13330 Usf Laurel Dr
Tampa, FL 33612-6601
Phone (138) 821-8008

Other identifiers 2

IdentifierTypeStateIssuer
112562300MedicaidFL
9SX3GOtherFLBLUE CROSS BLUE SHIELD

Other names 1

  • Tia Marie Fuller Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tfuller@tgh.org Health Information Exchange (HIE)
Direct Messaging Address tfuller173690@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211129001662 FL Practitioner - Nurse Practitioner 8628468048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17 Davis Blvd
Tampa, FL 33606-3475
Phone (813) 821-8038

4202 E Fowler Ave
Tampa, FL 33620-6750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11016094FLMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc CurrentSince Oct 26, 2021 Accepting new patients
University Medical Service Association Inc CurrentSince Oct 26, 2021 Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc Current Accepting new patients
University Medical Service Association Inc PastSince Mar 24, 2025 Accepting new patients

Locations

17 Davis Blvd
Ste 402
Tampa, FL 33606
Phone (813) 259-8689

12901 Bruce B Downs Blvd
#19
Tampa, FL 33612
Phone (813) 974-1469

13330 Usf Laurel Dr
Tampa, FL 33612
Phone (813) 396-9478

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

17 Davis Blvd
Tampa, FL 33606
Phone (813) 250-2506

1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-0793

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1033872767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 DAVIS BLVD STE 402",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063438",
            "telephone_number": "813-821-8008",
            "fax_number": "813-821-8355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13330 Usf Laurel Dr",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336126601",
            "country_code": "US",
            "telephone_number": "138-821-8008",
            "fax_number": "813-821-8327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAAS",
        "first_name": "TIA",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-19",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "APRN11016094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112562300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9SX3G",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfuller@tgh.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1 Tampa General Cir",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336063571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfuller173690@direct.tgh.org",
            "affiliation": "N",
            "address_1": "13330 Usf Laurel Dr",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336126601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "FULLER",
            "middle_name": "MARIE",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.