Provider Demographics
NPI:1922254747
Name:PANDIS, DUELLYN Z (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:DUELLYN
Middle Name:Z
Last Name:PANDIS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5241
Mailing Address - Country:US
Mailing Address - Phone:813-969-3757
Mailing Address - Fax:813-969-3052
Practice Address - Street 1:4204 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5241
Practice Address - Country:US
Practice Address - Phone:813-969-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2855132163W00000X, 163WX0106X
FL2855132363L00000X
FLARNP28551322083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherOTHER