Healthcare Provider Details

I. General information

NPI: 1023864121
Provider Name (Legal Business Name): SEASIDE WELLNESS PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 ULMERTON RD
LARGO FL
33771-4548
US

IV. Provider business mailing address

7531 ULMERTON RD
LARGO FL
33771-4548
US

V. Phone/Fax

Practice location:
  • Phone: 727-270-5047
  • Fax: 727-877-3735
Mailing address:
  • Phone: 727-270-5047
  • Fax: 727-877-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTA B SHENKMAN
Title or Position: OWNER
Credential:
Phone: 727-270-5047