Healthcare Provider Details

I. General information

NPI: 1306519962
Provider Name (Legal Business Name): THRIVE FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 SHUMARD OAK DR UNIT 105
LAND O LAKES FL
34638-7257
US

IV. Provider business mailing address

10724 BURNING BUSH TER
LAND O LAKES FL
34638-6883
US

V. Phone/Fax

Practice location:
  • Phone: 813-751-5074
  • Fax:
Mailing address:
  • Phone: 813-751-5074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA TRNKA-STONE
Title or Position: OWNER
Credential: APRN-DNP
Phone: 813-751-5074