Individual provider Active NPI

Thuy Linh Pham, APRN

  • Adult Health Nurse Practitioner
  • Lakeland, FL
National Provider Identifier
1104654862
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11036048 Issued in FL
Practice address
3647 Innovation Dr
Lakeland, FL 33812-4106
Phone
(863) 272-6990
NPI assigned
Jul 24, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APRN11036048 FL Primary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 11036048 FL

Addresses

Primary practice location

3647 Innovation Dr
Lakeland, FL 33812-4106

Mailing address

3647 Innovation Dr
Lakeland, FL 33812-4106

Other practice location 1

1717 S Orange Ave Ste 103
Orlando, FL 32806-2946
Phone (321) 841-4344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241031001408 FL Practitioner - Nurse Practitioner 6800329632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1720 S Orange Ave
Suite 200
Orlando, FL 32806-2932
Phone (321) 841-4344

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11036048FLMDNurse Practitioner
APRN11036048FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Nov 1, 2024 Accepting new patients
Orlando Health Medical Group Inc Single Specialty CurrentSince Nov 1, 2024 Accepting new patients

Locations

1720 S Orange Ave
Ste 200
Orlando, FL 32806
Phone (407) 426-9693

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

1717 S Orange Ave
Ste 103
Orlando, FL 32806
Phone (407) 236-0404

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1104654862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3647 INNOVATION DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3647 INNOVATION DR",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338124106",
            "telephone_number": "863-272-6990"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 S Orange Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328062946",
            "country_code": "US",
            "telephone_number": "321-841-4344",
            "fax_number": "321-843-1753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "THUY LINH",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-24",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11036048",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11036048",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.