Healthcare Provider Details

I. General information

NPI: 1629827209
Provider Name (Legal Business Name): ALYSSA THURBER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD STE 275
LARGO FL
33777-1260
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-394-5650
  • Fax: 727-635-7939
Mailing address:
  • Phone: 727-281-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: