Provider Demographics
NPI:1063254290
Name:THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES
Entity type:Organization
Organization Name:THE UNIVERSITY OF SOUTH FLORIDA BOARD OF TRUSTEES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:DUELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:813-396-0234
Mailing Address - Street 1:12901 BRUCE B DOWNS BLVD
Mailing Address - Street 2:MDC 22
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-396-0234
Mailing Address - Fax:866-922-6915
Practice Address - Street 1:1309 SHORELINE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605
Practice Address - Country:US
Practice Address - Phone:813-396-0234
Practice Address - Fax:866-922-6915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF SOUTH FLORIDA BOT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care