Provider Demographics
NPI:1538887682
Name:THOMPSON, TROY JACOB (PA-C)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:JACOB
Last Name:THOMPSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8572 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4422
Mailing Address - Country:US
Mailing Address - Phone:727-420-8129
Mailing Address - Fax:
Practice Address - Street 1:203 N MARION ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4914
Practice Address - Country:US
Practice Address - Phone:813-474-9804
Practice Address - Fax:813-540-6025
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant