Provider Demographics
NPI:1306519962
Name:THRIVE FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:THRIVE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRNKA-STONE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-DNP
Authorized Official - Phone:813-751-5074
Mailing Address - Street 1:10724 BURNING BUSH TER
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6883
Mailing Address - Country:US
Mailing Address - Phone:813-751-5074
Mailing Address - Fax:
Practice Address - Street 1:19455 SHUMARD OAK DR UNIT 105
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7257
Practice Address - Country:US
Practice Address - Phone:813-751-5074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111347200Medicaid