Name and Title
Name
*
First Name
Last Name
Please select which location(s) you will need privileges for
*
TGH Main
TGH Surgery Center at Morsani
Tampa General Surgery Center Brandon
TGH Rehabilitation Hospital (invitation only)
Tampa Behavioral Health Hospital (invitation only)
University of Tampa - Student Health Clinic (student health clinic providers only
Title
*
Please Select
APRN
CNM
CRNA
PA
SFA
RNFA
Department/Specialty
*
Please Select
Addiction Medicine
Adult Reconstructive Orthopaedic Surgery
Advanced Heart Failure & Transplant Cardiology
Allergy & Immunology
Anatomic Pathology & Clinical Pathology
Anesthesiology
Bariatric Medicine
Bariatric Surgery
Blood Banking & Transfusion Medicine
Bone Marrow Transplantation
Breast Surgery
Cardio-thoracic Anesthesia
Cardiovascular Disease
Child & Adolescent Psychiatry
Clinical Cardiac Electrophysiology
Clinical Neurophysiology
Colon & Rectal Surgery
Cornea & External Diseases
Critical Care Medicine
Dentistry - Oral & Maxillofacial Surgery
Dermatology
Diagnostic Radiology
Emergency Medicine
Endocrinology, Diabetes & Metabolism
Family Medicine
Female Pelvic Medicine & Reconstructive Surgery
Foot & Ankle Surgery
Gastroenterology
General Surgery
Geriatric Medicine
Gynecologic Oncology
Gynecology
Hand Surgery
Hematology
Hematology & Oncology
Hepatology
Hip & Joint Surgery
Hospice & Palliative Care
Hospital Medicine
Infectious Disease
Internal Medicine
Internal Medicine & Pediatrics
Interventional Cardiology
Maternal & Fetal Medicine
Medical Oncology
Medical Toxicology
Neonatal-Perinatal Medicine
Nephrology
Nephrology Transplantation (Non-Surgical)
Neurocritical Care
Neurological Skull Base Surgery
Neurological Spine Surgery
Neurological Surgery
Neurology
Neuro-Ophthalmology
Neuroradiology
Nuclear Cardiology
Nuclear Radiology
Obstetrics & Gynecology
Ophthalmic Plastic & Reconstructive Surgery
Ophthalmology
Orthopaedic Musculoskeletal Oncology
Orthopaedic Surgery
Orthopaedic Surgery of the Spine
Orthopaedic Trauma
Orthopaedic Trauma Surgery
Otolaryngology
Pain Medicine
Pediatric Allergy/Immunology
Pediatric Anesthesiology
Pediatric Bariatric Medicine
Pediatric Cardiology
Pediatric Critical Care Medicine
Pediatric Dentistry
Pediatric Emergency Medicine
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Genetics
Pediatric Hematology-Oncology
Pediatric Hospital Medicine
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Neurology
Pediatric Neurosurgery
Pediatric Ophthalmology & Strabismus
Pediatric Orthopaedic Surgery
Pediatric Otolaryngology
Pediatric Pathology
Pediatric Pulmonary
Pediatric Rehabilitation Medicine
Pediatric Sleep Medicine
Pediatric Surgery
Pediatric Urology
Pediatrics
Physical Medicine & Rehabilitation
Plastic & Reconstructive Surgery
Plastic Surgery
Plastic Surgery within the Head & Neck
Podiatry
Preventive Medicine/Occupational Environmental Medicine
Procurement
Psychiatry
Psychology
Psychology - Behavioral Pain Management
Psychology - Behavioral Sleep Medicine
Psychology - Clinical
Psychology - Clinical Child & Adolescent
Psychology - Health
Psychology - Neurophysiology
Psychology - Pediatric Neuropsychology
Psychology - Rehabilitation
Pulmonary Disease
Pulmonary Transplantation (Non-Surgical)
Radiation Oncology
Reproductive Endocrinology
Retina
Rheumatology
Shoulder & Elbow Surgery
Sleep Medicine
Spinal Cord Injury Medicine
Sports Medicine
Surgical Critical Care
Surgical Oncology
Thoracic Surgery (Cardiothoracic Vascular Surgery)
Transplant Hepatology
Transplant Surgery (Abdominal)
Transplant Surgery (Cardiothoracic)
Trauma Surgery
Urology
Vascular & Interventional Radiology
Vascular Surgery
Office Address
Group Name
*
Please Select
Other
Group Name
*
Please Select
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
TGH/TGMG - Cardiology
USF Division of Cardiovascular Services
Other
Group Name
*
Please Select
Advanced Allergy & Asthma Care, PLLC
Allergy, Asthma & Immunology Associates of Tampa Bay
USF Division of Allergy and Immunology
Other
Group Name
*
Please Select
Ruffolo, Hooper & Associates MD, PA
USF Department of Pathology and Cell Biology
Other
Group Name
*
Please Select
Anesthesia 3.0 LLC
Breakthru Anesthesiology
Gulf-to-Bay Anesthesiology Associates, LLC - Anesthesia
Gulf-to-Bay Anesthesiology Associates, LLC - Critical Care
J. Paul Augereau, MD, PA
Minnea B. Kalra
Other
Group Name
*
Please Select
TGH/TGMG - Bariatric Surgery
Other
Group Name
*
Please Select
TGH/TGMG - Bariatric Surgery
USF Division of Bariatric Surgery
Other
Group Name
*
Please Select
OneBlood, Inc.
Other
Group Name
*
Please Select
Cancer Center of South Florida
Other
Group Name
*
Please Select
Tampa Bay Surgical Group, LLC
TGH/TGMG - Breast Surgery
USF Division of Breast Surgery
Women's Care Florida - Breast Surgery
Other
Group Name
*
Please Select
Gulf-to-Bay Anesthesiology Associates, LLC - Anesthesia
Gulf-to-Bay Anesthesiology Associates, LLC - Cardiothoracic Anesthesia
Other
Group Name
*
Please Select
Arthur Labovitz, MD
Bay Area Cardiology Associates, PA
Brandon Cardiology Clinic, PA
Cardiovascular Center of Tampa, PA
Cardiovascular Institute of America, P.A.
Dhiraj Warman, MD PA
Florida Cardiac Therapeutics Inc
Florida Medical Clinic, PA - Cardiology
Florida Medical Group, PA - Cardiology
H. Lee Moffitt Cancer Center - Cardiology
Harrison Cardiovascular Center, PA
Heart Vascular and Vein of Tampa Bay LLC
James A. Haley Veteran's Hospital - Cardiology
Pasco Cardiology Associates
Praveen Kumar Rohatgi, MD, PA
Preventative & Interventional Cardiology
South Tampa Cardiology
TGH/TGMG - Cardiology
The Advanced Cardiovascular Center of Tampa Bay, PA
USF Division of Cardiovascular Services
Other
Group Name
*
Please Select
USF Department of Psychiatry and Behavioral Neuroscience
Other
Group Name
*
Please Select
Bay Area Cardiology Associates, PA
TGH/TGMG - Cardiology
USF Division of Cardiovascular Services
Other
Group Name
*
Please Select
Florida Center for Neurology
USF Department of Neurology
Other
Group Name
*
Please Select
TGH/TGMG - Colon & Rectal Surgery
USF Division of Colorectal Surgery
Other
Group Name
*
Please Select
USF Department of Ophthalmology
Other
Group Name
*
Please Select
Gulf-to-Bay Anesthesiology Associates, LLC - Critical Care
LyraCore Health Alliance Pulmonary Division
Tampa Pulmonary and Sleep Specialists
USF Division of Pulmonary - Critical Care
Other
Group Name
*
Please Select
Christopher M. Donato, DMD, PA
David McDonald, DMD, PA
Florida Craniofacial Institute, PA
Florida Special Care Dentistry
Harold B. Welch, DMD., PA
Jack A. Davidson, DDS, MD, PLLC
New Concept Sleep
Suncoast Community Health Centers, Inc.
Other
Group Name
*
Please Select
Academic Alliance in Dermatology
Colorado Health and Youth
Hernando Skin and Cancer Center, PA
Luis T. Menendez, MD, PA
Michael A. Scannon, MD, PA
USF Department of Dermatology & Cutaneous Surgery
Other
Group Name
*
Please Select
Radiology Associates of Tampa, Inc.
Radiology Associates of Tampa, P.A.
USF Department of Radiology
Other
Group Name
*
Please Select
InPhyNet Contracting Services, LLC
USF Department of Emergency Medicine
Other
Group Name
*
Please Select
Bay Area Endocrinology, PA
Monther Al-Halawani, MD, PA
Tampa Bay Diabetes Thyroid & Endocrinology Center
Tampa Bay Endocrinology, PA
TGH/TGMG - Endocrinology
USF Division of Endocrinology & Metabolism
Other
Group Name
*
Please Select
Bay Health Center
Cooperative Med
Family Medical Hospitalist
Florida Family Practice & Urgent Care LLC
Florida Hospital - Family Medicine
Live Better Health Center, LLC
Orlando Internal Medicine, PA
Pinnacle Health Group, PA
Professional Health Care of Pinellas, LLC
Radley L. Griffin, MD, PL
Sanitas Medical Center
Suncoast Community Health Centers, Inc.
TGH/TGMG - Bariatric Surgery
TGH/TGMG - Family Medicine
USF Department of Family Medicine
Other
Group Name
*
Please Select
Florida Female Urology
The Pelvic Floor Institute, LLC
USF Division of Urogynecology
Other
Group Name
*
Please Select
Florida Orthopaedic Institute
The Center for Bone and Joint Disease, PA
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Digestive Diseases Associates of Tampa Bay
Eugene A. Ward, MD, PA
Florida Medical Clinic, PA - Gastroenterology
Gastroenterology of Greater Orlando
H. Lee Moffitt Cancer Center - Gastroenterology
Imad Nakshabendi, MD, PA, FACG
John I. Delgado, MD, PA
Luis J. Lopez, MD, PA
Shawkat Kero, MD PA
Suncoast GI Associates, PA
TGH/TGMG - Gastroenterology
USF Division of Digestive Diseases and Nutrition
Whitaker, Weintraub, Grizzard MDs, PA
Other
Group Name
*
Please Select
Castellano Cosmetic Surgery Center, PA
Clayman Thyroid Cancer Center
Florida Hospital - General Surgery
Lutz Surgical Partners, PLLC
Norman Parathyroid Center, PA
Stephan Surgical Arts
Tampa Bay Surgical Group, LLC
TGH/TGMG - General Surgery
TGH/TGMG - Parathyroid/Thyroid
USF Division of General Surgery
Other
Group Name
*
Please Select
Sanitas Medical Center
TGH/TGMG - Geriatric Medicine
Other
Group Name
*
Please Select
H. Lee Moffitt Cancer Center - Gynecologic Oncology
TGH/TGMG - Gynecology Oncology
USF Division of Gynecology Oncology
Other
Group Name
*
Please Select
Margarita Gelpi MD, PA
Planned Parenthood of Southwest and Central Florida, Inc.
USF Department of Obstetrics & Gynecology
Other
Group Name
*
Please Select
Florida Orthopaedic Institute
MacDill AFB - Orthopedic Surgery
NW Tampa Surgical Associates, LLC
Plastic Surgery Center of Tampa
Other
Group Name
*
Please Select
Florida Cancer Specialists & Research Institute, LLC
Other
Group Name
*
Please Select
Cancer Center of South Florida
Florida Cancer Specialists & Research Institute, LLC
H. Lee Moffitt Cancer Center - Hematology/Oncology
Jawan Ayer-Cole, MD, LLC
TGH/TGMG - Hematology/Oncology
University Hematology & Oncology, PA
USF Division of Hematology & Medical Oncology
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Florida Orthopaedic Institute
TGH/TGMG - Orthopaedic Surgery
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Sanitas Medical Center
Bay Area Hospitalists, P.A.
First Knight Medical, Inc
Lifepath Hospice, Inc.
TGH/TGMG - Hospice & Palliative Care
USF Division of Hospice & Palliative Care
Other
Group Name
*
Please Select
InPhyNet Contracting Services, LLC
Live Better Health Center, LLC
Premier Hospitalists PL
Sanitas Medical Center
VP Health
Accord Medical Group
Alvior Medical Clinic
Bay Area Hospitalists, P.A.
Florida Medical Clinic, PA - Hospital Medicine
Inpatient Specialists Group LLC
Optum - Hospital Medicine
Optum - Internal Medicine
Palma Ceia Family Care, PL
Premier Hospitalists PL
Prime Care of Tampa Bay
TBIM Hospitalists
TGH/TGMG - Hospital Medicine
The Health Associates of Tampa
USF Division of Hospital Medicine
VP Health
USF Department of Internal Medicine
Other
Group Name
*
Please Select
Gulf To Bay Infectious Disease Consultants
ID Team, PA
Infectious Disease Associates of Tampa Bay
Infectious Disease Consultants of West Florida
TGH/TGMG - Infectious Diseases
USF Division of Infectious Diseases & International Medicine
USF Department of Internal Medicine
Other
Group Name
*
Please Select
Advanced Primary Care and Laser Institute of New Tampa
BayCare Medical Group, Inc - Internal Medicine
Benjamin Mena, MD, PA
Carlos B. Pagan, MD
Chambers Medical Group
Chapters Health
LoCicero Medical Group - Internal Medicine
New Tampa Medical Center
North Armenia Medical Walk-In Clinic
Olayinka A. Bankole, MD, PA
Pinnacle Health Group, PA
R. Maurice Bonilla, MD, PA
R.K. Moorthy, MD
Salman Ahmed LLC
Suncoast Community Health Centers, Inc.
Tampa Internist, PA
TGH/TGMG - Internal Medicine
USF Department of Internal Medicine
Whitaker, Weintraub, Grizzard MDs, PA
Other
Group Name
*
Please Select
TGH/TGMG - Internal Medicine
USF Department of Internal Medicine
USF Department of Pediatrics
Other
Group Name
*
Please Select
Ascent Cardiology Group LLC
Bay Area Cardiology Associates, PA
Florida Medical Group, PA - Interventional Cardiology
Heart and Vascular Associates of Tampa, LLC
Heart Vascular and Vein of Tampa Bay LLC
Hesham Fakhri MD PLLC
TGH/TGMG - Interventional Cardiology
USF Division of Cardiovascular Services
Vein Heart and Vascular Institute
Other
Group Name
*
Please Select
USF Division of Maternal Fetal Medicine
Women's Care Florida - Maternal Fetal Medicine
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
InPhyNet Contracting Services, LLC
Other
Group Name
*
Please Select
TGH/TGMG - Pediatric Neonatology
USF Division of Pediatric Neonatology
Other
Group Name
*
Please Select
Alberto B. Caintic, MD
All Kidney Care P.A.
Fernando Rodriguez, MD, PA
Florida Kidney Physicians LLC
Optum - Nephrology
Renal Care of Tampa Bay
Tampa Bay Nephrology Associates, PL
USF Division of Nephrology & Hypertension
Other
Group Name
*
Please Select
Florida Kidney Physicians LLC
TGH/TGMG - Nephrology
Other
Group Name
*
Please Select
USF Department of Neurology
USF Department of Neurosurgery & Brain Repair
Other
Group Name
*
Please Select
USF Department of Neurosurgery & Brain Repair
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Advanced Neurosurgery & Spine Center, PA
Henkin Neurosurgery, PA
Larry Fishman, MD
Lucy C Love, MD, PA
NeuSpine Institute LLC
TGH/TGMG - Neurosurgery
USF Department of Neurosurgery & Brain Repair
Florida Orthopaedic Institute
Other
Group Name
*
Please Select
Advanced Medical Resources, LLC
American Telestroke and Neurology Inc
Bay Area Neurology LLC
Florida Comprehensive Epilepsy/Seizure Center
Florida Neurovascular Institute, PA
Neurologic Care Center, PA
Neurology & Physical Therapy Center of Tampa Bay
Neurophysiology Center, PA
NuVasive Clinical Services Monitoring Inc.
Remyelix Neurology & Multiple Sclerosis Institute, PLLC
Specialty Care - Neurointeroperative Monitoring
Tampa Bay Neurology and Sleep Medicine, LLC
Tampa Neurology Associates, P.A.
TGH/TGMG - Neurology
USF Department of Neurology
Vincent DiCarlo, MD and Associates, PA
Other
Group Name
*
Please Select
USF Department of Ophthalmology
Other
Group Name
*
Please Select
Radiology Associates of Tampa, P.A.
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Radiology Associates of Tampa, P.A.
Other
Group Name
*
Please Select
Armando Nicolas Gutierrez, MD
Omni Medical Center for Women PLC
Planned Parenthood of Southwest and Central Florida
Planned Parenthood of Southwest and Central Florida, Inc.
Shady Grove Fertility of Tampa Bay
South Tampa Gynecology
Tampa Obstetrics, P.A.
TGH/TGMG - Obstetrics & Gynecology
USF Department of Obstetrics & Gynecology
USF Division of Midwifery
Women's Care Florida - Obstetrics & Gynecology
Women's Health Care
Other
Group Name
*
Please Select
USF Department of Ophthalmology
William Mack, MD, PA
Other
Group Name
*
Please Select
Bay Area Eye Institute
Bradley D. Fouraker MD, LLC
Brandon Eye Associates, PA
Center for Sight
Commonwealth Vision
Eye Institute of West Florida
Florida Eye & Laser Institute
Florida Eye Specialists & Cataract Institute
Geoffrey M. Kwitko, MD
MacDill Ophthalmology 6th Medical Group
Mark E. Hammer, MD
Newsom Eye & Laser Center, Inc.
Orlick, Berger, Kasper & Patel, MDs, PA
Perez Eye Center, P.L.
Retina Associates of Florida, LLC
St Michaels Eye and Laser Institute, Inc
Stephenson Eye Associates
Tampa Eye Clinic and Associates, P.A.
USF Department of Ophthalmology
Frank I. Mendelblatt, MD, PA
Other
Group Name
*
Please Select
H. Lee Moffitt Cancer Center - Musculoskeletal Oncology
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Florida Medical Clinic, PA - Orthopaedic Surgery
Florida Orthopaedic Institute
Orthopedic Surgery of the Spine
Outpatient Joint Center of America
Physicians Regional Medical Group
Tampa Bay Surgery Specialists, PA
TGH/TGMG - Orthopaedic Surgery
The Center for Bone and Joint Disease, PA
USF Department of Orthopaedics and Sports Medicine
Westchase Sports Medicine & Orthopaedics
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
BioSpine Institute
Florida Orthopaedic Institute
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Florida Orthopaedic Institute
Other
Group Name
*
Please Select
Brett M. Scotch D.O., F.A.O.C.O.
Clayman Thyroid Cancer Center
Edward B. Kampsen, MD, PA
Edward H. Farrior, MD
Florida ENT and Allergy
Francis W. Rieger, MD
H. Lee Moffitt Cancer Center - Otolaryngology
Rejuvenate LLC
Roger E. Bassin MD, PA
Tampa Bay Hearing & Balance Center, PL
Tampa Pediatric ENT Associates, PLLC
USF Department of Otolaryngology - Head & Neck Surgery
Vitale Institute, P.L.
Other
Group Name
*
Please Select
Comprehensive Spine Institute, LLC
Florida Medical Clinic, PA - Pain Medicine
Gulf-to-Bay Anesthesiology Associates, LLC - Pain Management
Immigration Exams of Tampa LLC
Interventional Spine and Diagnostics
J. Christie, MD, PA
Jorge J. Leal, MD
Nicholas Koehler, PA
Omni Pain Care, PA
The Peregrine Institute
Transitional Pain & Specialty Group, LLC
USF Department of Neurology
Other
Group Name
*
Please Select
Aspire Allergy & Sinus of Florida, PLLC
Roberto Garcia, MD, PA
Other
Group Name
*
Please Select
Gulf-to-Bay Anesthesiology Associates, LLC - Pediatric Anesthesia
Pediatric Dental Anesthesia Associates, LLC
Other
Group Name
*
Please Select
USF Division of Adolescent Medicine
Other
Group Name
*
Please Select
Bay Pediatric Cardiology, Inc.
Johns Hopkins ACH - Pediatric Cardiology
Nemours Children's Hospital - Pediatric Cardiology
Pediatric Cardiology Associates
Pediatric Cardiology Specialists, LLC
Pediatric Physician Services, Inc.
Tampa Bay Adult Congenital Heart Center
Other
Group Name
*
Please Select
Centene Corporation
Florida Pediatric Associates, LLC
TGH/TGMG - Pediatric Pulmonary Critical Care
Other
Group Name
*
Please Select
Kids Smiles Partners, PLLC
Shiny Teeth Pediatric Dentistry
Smile Builders
Suncoast Community Health Centers, Inc.
Tampa Family Health Center, Inc. - Pediatric Dentistry
Other
Group Name
*
Please Select
InPhyNet Contracting Services, LLC
Other
Group Name
*
Please Select
USF Division of Pediatric Diabetes and Endocrinology
Other
Group Name
*
Please Select
Pediatric Gastro., Hepatology & Nutrition of Florida, PA
USF Department of Pediatrics
Other
Group Name
*
Please Select
Johns Hopkins ACH - Medical Genetics
USF Division of Pediatric Genetics and Metabolism
Other
Group Name
*
Please Select
Cameron K. Tebbi, M.D.
Johns Hopkins ACH - Pediatric Hematology Oncology
Pediatric Physician Services, Inc.
USF Division of Pediatric Hematology Oncology
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
USF Division of Pediatric Infectious Diseases
Other
Group Name
*
Please Select
Johns Hopkins ACH - Pediatric Nephrology
USF Division of Pediatric Nephrology
Capernaum Medical Center
Edgard Andrade MD
Pediatric Epilepsy & Neurology Specialists
Sergio J. Jacinto, MD, PA
USF Division of Pediatric Neurology
Other
Group Name
*
Please Select
USF Division of Pediatric Neurology
Other
Group Name
*
Please Select
Johns Hopkins ACH - Pediatric Neurosurgery
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Shriners Hospitals for Children
Timothy M. Bradley MD, Pediatric Orthopaedic Surgeon PA
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
USF Department of Pathology and Cell Biology
Other
Group Name
*
Please Select
USF Division of Pediatric Pulmonary
Other
Group Name
*
Please Select
Rehabilitation and Electrodiagnostics PA
TGH/TGMG - Pediatric Rehabiliation Medicine
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Johns Hopkins ACH - Pediatric Surgery
TGH/TGMG - Pediatric Surgery
USF Division of Pediatric Surgery
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
All Kids Pediatrics, P.A.
Children's Health Center, Inc.
Florida Pediatric Associates, LLC
Johns Hopkins ACH - Pediatrics
Pediatric Associates of Tampa Bay
SunCoast Community Health Centers, Inc.
TGH/TGMG - Pediatric Pulmonary Critical Care
USF Department of Pediatrics
USF Division of Pediatric Child Protection Team
Other
Group Name
*
Please Select
Florida Medical Clinic, PA - Rehabilitation
James R. Patterson, MD, PA
Radial Health Southeast, LLC
Rehabilitation and Electrodiagnostics PA
Transitional Pain & Specialty Group, LLC
USF Department of Neurosurgery & Brain Repair
Other
Group Name
*
Please Select
Soler Plastic & Reconstructive Surgery
Other
Group Name
*
Please Select
Anthony Watt MD, PA
Artisan Aesthetics Plastic Surgery & Laser Center
Coberly Plastic Surgery
Center for Surgical Excellence
Ernesto Ruas, MD, PA
Johns Hopkins ACH - Plastic Surgery
Joseph J. Hirschfeld, MD
Joshua A. Halpern, MD, PA
Karen E. Wells, MD, PA
Laufer Institute of Plastic Surgery
LMB Institute, Inc.
Luis Aponte, MD, PA
Marcadis Plastic Surgery
Moriah R Moffitt, MD, PA
Physicians Surgical Center of Tampa LLC
Plastic Surgery Center of Tampa
Tampa Aesthetic & Plastic Surgery
Tampa Bay Plastic Surgery Inc
TGH/TGMG - Plastic Surgery
USF Division of Plastic Surgery
VIVIFY Plastic Surgery
Wayne Lee MD Plastic Surgery PLLC
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
American Foot & Ankle Clinic of Tampa Bay Inc
Ankle and Foot Associates, P.A.
Bayshore Podiatry Center
Florida Coast Foot and Ankle Center, PA
Ryan Ellis, DPM
The Foot & Leg Medical Center
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
TransMedic
USF Division of Cardiothoracic and Transplantation Surgery
Other
Group Name
*
Please Select
George M. Northrup, MD, PA
Neurobehavioral Medicine, LLC
TGH/TGMG - Psychiatry
USF Department of Psychiatry and Behavioral Neuroscience
Other
Group Name
*
Please Select
TGH/TGMG - Psychology
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Behavioral Health of South Tampa
Florida Medical Psychology Associates, LLC
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
USF Department of Neurosurgery & Brain Repair
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Bay Pines VA Medical Center - Pulmonary Disease
Carpenter Health, PA
Florida Medical Clinic, PA - Pulmonary
Ivan F. Ackerman, MD, PA
Stephen Kreitzer, MD PA
Tampa Pulmonary and Sleep Specialists
Other
Group Name
*
Please Select
USF Division of Pulmonary - Critical Care
USF Division of Pulmonary - Transplant
Other
Group Name
*
Please Select
Florida Cancer Specialists & Research Institute, LLC
Florida Urology Partners, LLP - Radiation Oncology
Heysek & Kepes Radiation Oncology
Hyde Park Cancer Center
Tampa Bay Radiation Oncology, P.A.
Tampa Oncology and Proton
TGH/TGMG - Radiation Oncology
USF Division of Radiation Oncology
Other
Group Name
*
Please Select
USF Division of Reproductive Endocrinology
Other
Group Name
*
Please Select
Perez Eye Center, P.L.
Retina Associates of Florida, LLC
Other
Group Name
*
Please Select
USF Division of Rheumatology
Other
Group Name
*
Please Select
Florida Orthopaedic Institute
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
Sanitas Medical Center
AdventHealth-Tampa Sleep Center
Tampa Pulmonary and Sleep Specialists
USF Division of Pulmonary - Sleep Medicine
Other
Group Name
*
Please Select
Other
Group Name
*
Please Select
Sanitas Medical Center
USF Department of Orthopaedics and Sports Medicine
MacDill AFB - Orthopedic Surgery
Other
Group Name
*
Please Select
USF Department of Neurosurgery & Brain Repair
USF Division of Pulmonary - Critical Care
Other
Group Name
*
Please Select
H. Lee Moffitt Cancer Center - Surgical Oncology
USF Division of Surgical Oncology
Other
Group Name
*
Please Select
Cedars Heart Institute
Esfandiar Shafii, MD., PLLC
Gulf to Bay Cardiovascular/Thoracic
Husain F. Nagamia, MD, PA
R. Vijay, MD, FACS
TGH/TGMG - Cardiothoracic Surgery
USF Division of Cardiothoracic and Transplantation Surgery
Other
Group Name
*
Please Select
TGH/TGMG - Gastroenterology
TGH/TGMG - Transplant Hepatology
Other
Group Name
*
Please Select
TGH/TGMG - General Surgery
TGH/TGMG - Transplant Surgery (Abdominal)
Other
Group Name
*
Please Select
TGH/TGMG - Transplant Surgery (Cardiothoracic)
USF Division of Cardiothoracic and Transplantation Surgery
Other
Group Name
*
Please Select
Sarasota Memorial Hospital
TGH/TGMG - Trauma Surgery
USF Division of Acute Care Surgery
Other
Group Name
*
Please Select
American Surgical Professionals
Florida Urology Oncology and Urogynecology, LLC
Florida Urology Partners, LLP
Gary Ronay, MD., P.A.
H. Lee Moffitt Cancer Center - Urology
Plant City Urology Associates, INC
Richard R. Landrigan, MD, LLC
TGH/TGMG - Urology
USF Department of Urology
Other
Group Name
*
Please Select
Florida Interventional Specialists
Radiology Associates of Tampa, P.A.
Other
Group Name
*
Please Select
James A. Haley Veteran's Hospital - Vascular Surgery
TGH/TGMG - Vascular Surgery
USF Division of Vascular Surgery
Other
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Office Phone
*
Please enter a valid phone number.
Office Fax
*
Please enter a valid phone number.
Group Tax ID
Group Tax ID#
*
Home Address
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone
*
Please enter a valid phone number.
Contact Preferences
Email Application to
*
Personal Email
Work Email
Preferred Contact Number
*
Cell
Home
Office
Office Administrator Contact Information
Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Personal Information
NPI Registry
DOB
*
-
Month
-
Day
Year
SSN
*
Personal Email
*
example@example.com
Work Email
example@example.com
Cell Phone
*
Please enter a valid phone number.
Advanced Professional Education
*
Graduation Date
*
-
Month
-
Day
Year
Date
NPI
*
Curriculum Vitae (CV)
Heading
CV
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Employment
Anticipated Start Date
*
-
Month
-
Day
Year
Name of Supervising Physician at TGH*
*
*Must hold privileges at TGH
Are you employed by TGH or TGMG?
*
Please Select
Yes
No
Are you privileged at BHP or Morsani ASC
*
Please Select
Yes
No
ID Number
*
Are you applying as a Locums Tenens?
*
Please Select
Yes
No
Were you previously credentialed at TGH?
Please Select
Yes
No
What year did you come off staff?
Submit
Should be Empty: