| Trinity Family And Sports Medicine Pa | |
|
1807 Short Branch Dr #102 Trinity FL 34655-4415 | |
| (727) 376-3547 | |
| (866) 439-9035 |
| Full Name | Trinity Family And Sports Medicine Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1807 Short Branch Dr, Trinity, Florida |
| Authorized Official Name and Position | Jesse D Tippett (OWNER) |
| Authorized Official Contact | 7273763547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Family And Sports Medicine Pa 1807 Short Branch Drive #102 Trinity FL 34655 Ph: (727) 376-3547 | Trinity Family And Sports Medicine Pa 1807 Short Branch Dr #102 Trinity FL 34655-4415 Ph: (727) 376-3547 |
| NPI Number | 1891991238 |
|---|---|
| Provider Enumeration Date | 06/22/2007 |
| Last Update Date | 07/12/2016 |
| Medicare PECOS PAC ID | 3971680646 |
|---|---|
| Medicare Enrollment ID | O20080404000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891991238 | NPI | - | NPPES |
| 279176500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | ME93868 (Florida) | Primary |
| Provider Name | Jesse Tippett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083717862 PECOS PAC ID: 6800812140 Enrollment ID: I20051017000656 |
| Provider Name | Mary Lisa Goodman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265105803 PECOS PAC ID: 4385016401 Enrollment ID: I20230217001166 |
| Provider Name | Juliane Chavez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275018749 PECOS PAC ID: 1052785342 Enrollment ID: I20230328003107 |
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Incentive Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3535 Little Rd, Trinity, FL 34655 Phone: 727-375-0848 | |
Trinity Family Healthcare Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3633 Little Rd, Suite # 103, Trinity, FL 34655 Phone: 727-853-1800 Fax: 727-853-1807 | |
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