NPIMap

Organization Active NPI

The University of South Florida Board of Trustees

  • Family Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1063254290
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES
Practice address
1309 Shoreline Ave
Tampa, FL 33605
Phone
(813) 396-0234
Fax
(866) 922-6915
NPI assigned
Jun 10, 2024
Organization subpart
Yes
Parent organization
THE UNIVERSITY OF SOUTH FLORIDA BOTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Duellyn Pandis, DNP, APRN, FNP-C
Title
Director of Clinical Practice
Phone
(813) 396-0234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1309 Shoreline Ave
Tampa, FL 33605

Mailing address

12901 Bruce B Downs Blvd
MDC 22
Tampa, FL 33612
Phone (813) 396-0234

Other names 1

  • USFCollege of Nursing Port of Tampa Seafarers Ctr Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
University of South Florida Board of Trustees11 organizations share this tax ID, including this one
Part of
University of South Florida Board of Trustees

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1309 Shoreline Ave
Tampa, FL 33605
Phone (813) 396-0234

NPI Registry JSON

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1063254290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12901 BRUCE B DOWNS BLVD",
            "address_2": "MDC 22",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-396-0234",
            "fax_number": "866-922-6915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 SHORELINE AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33605",
            "telephone_number": "813-396-0234",
            "fax_number": "866-922-6915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE UNIVERSITY OF SOUTH FLORIDA BOT",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "PANDIS",
        "authorized_official_first_name": "DUELLYN",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL PRACTICE",
        "authorized_official_telephone_number": "813-396-0234",
        "authorized_official_credential": "DNP, APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USFCollege of Nursing Port of Tampa Seafarers Ctr Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.