Provider Demographics
NPI:1275231029
Name:STREET, TRISHA JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:JEAN
Last Name:STREET
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2862 ST CROIX DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2016
Mailing Address - Country:US
Mailing Address - Phone:727-871-6585
Mailing Address - Fax:
Practice Address - Street 1:1200 S PINELLAS AVE STE 10
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3716
Practice Address - Country:US
Practice Address - Phone:727-275-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily