Provider Demographics
NPI:1770239808
Name:ZEN ORCHID MEDICAL LLC
Entity Type:Organization
Organization Name:ZEN ORCHID MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:THOMAS-BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-471-6372
Mailing Address - Street 1:5800 49TH ST N # S-103
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2146
Mailing Address - Country:US
Mailing Address - Phone:727-471-6372
Mailing Address - Fax:727-471-4956
Practice Address - Street 1:5800 49TH ST N # S-103
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2146
Practice Address - Country:US
Practice Address - Phone:727-471-6372
Practice Address - Fax:727-471-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty