Healthcare Provider Details

I. General information

NPI: 1710084900
Provider Name (Legal Business Name): TRINITY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 COMMUNITY CT
HUDSON FL
34667-7101
US

IV. Provider business mailing address

7424 COMMUNITY CT
HUDSON FL
34667-7101
US

V. Phone/Fax

Practice location:
  • Phone: 727-233-7645
  • Fax: 727-233-7647
Mailing address:
  • Phone: 727-233-7645
  • Fax: 727-233-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberME029730
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. BO WILE HADDLE
Title or Position: PROVIDER RELATIONS REP.
Credential:
Phone: 727-233-7645