=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093614075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRITHERAPY SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 EE ST
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33815-4285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-315-4454
-----------------------------------------------------
Fax | 754-315-3207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4522 VINCENNES BLVD
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-8653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-315-4454
-----------------------------------------------------
Fax | 754-315-3207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGEMENT
-----------------------------------------------------
Name | GRETEL HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-349-8845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------