Healthcare Provider Details

I. General information

NPI: 1275448458
Provider Name (Legal Business Name): THUAN MINH TU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20756 LAKE VIENNA DR
LAND O LAKES FL
34638-8329
US

IV. Provider business mailing address

20756 LAKE VIENNA DR
LAND O LAKES FL
34638-8329
US

V. Phone/Fax

Practice location:
  • Phone: 813-928-9103
  • Fax:
Mailing address:
  • Phone: 813-928-9103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: