Healthcare Provider Details

I. General information

NPI: 1104748672
Provider Name (Legal Business Name): TRINITA LAFAYE MILLS-ROSS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 COMMERCIAL PARK DR
LAKELAND FL
33801-6569
US

IV. Provider business mailing address

37075 COLEMAN AVE
DADE CITY FL
33525-4530
US

V. Phone/Fax

Practice location:
  • Phone: 863-345-8090
  • Fax: 863-606-0146
Mailing address:
  • Phone: 863-345-8090
  • Fax: 863-606-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5252647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: