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Organization
TRINITY FAMILY AND SPORTS MEDICINE PA
Active
Organization
TRINITY FAMILY AND SPORTS MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE D TIPPETT MD (OWNER)
(727) 376-3547
Entity
Organization
Contact information
Practice address
1807 SHORT BRANCH DR, #102, TRINITY, FL 34655-4415
(727) 376-3547
(866) 439-9035
Mailing address
1807 SHORT BRANCH DRIVE, #102, TRINITY, FL 34655
(727) 376-3547
(866) 439-9035
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME93868
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279176500
—
FL
Enumeration date
06/22/2007
Last updated
07/12/2016
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