Healthcare Provider Details

I. General information

NPI: 1598782401
Provider Name (Legal Business Name): TRINITY FAMILY MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 PREVATT ST
EUSTIS FL
32726-6123
US

IV. Provider business mailing address

PO BOX 490
EUSTIS FL
32727-0490
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-2511
  • Fax: 352-253-2522
Mailing address:
  • Phone: 352-253-2511
  • Fax: 352-253-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number059170
License Number StateFL

VIII. Authorized Official

Name: STEPHEN E YOUNG
Title or Position: OWNER
Credential: DO
Phone: 352-253-2511