Provider Demographics
NPI:1497866560
Name:TAMPA INTERNIST PROFESSIONAL ASSOCIATE
Entity Type:Organization
Organization Name:TAMPA INTERNIST PROFESSIONAL ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-5098
Mailing Address - Street 1:5915 JAEGERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5864
Mailing Address - Country:US
Mailing Address - Phone:813-684-5098
Mailing Address - Fax:813-684-5098
Practice Address - Street 1:4543 S MANHATTAN AVE
Practice Address - Street 2:STE. 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2330
Practice Address - Country:US
Practice Address - Phone:813-831-8888
Practice Address - Fax:813-831-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care