Individual provider Active NPI

Michelle Nicole Lastra, PA-C

  • Medical Physician Assistant
  • Riverview, FL
National Provider Identifier
1275009631
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9111768 Issued in FL
Practice address
13134 Early Run LN
Riverview, FL 33578-3387
Phone
(813) 481-8969
NPI assigned
Oct 23, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 9111768 FL Primary

Addresses

Primary practice location

13134 Early Run LN
Riverview, FL 33578-3387

Mailing address

13134 Early Run LN
Riverview, FL 33578-3387

Other practice location 1

3301 W Gandy Blvd
Tampa, FL 33611-2931
Phone (813) 925-1903

Other identifiers 1

IdentifierTypeStateIssuer
130659300MedicaidFL

Other names 1

  • Michelle Nicole Hinson Former name

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
I20181210002957 FL Practitioner - Physician Assistant 4789928227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11969 Sheldon Rd
Tampa, FL 33626-3644
Phone (813) 925-1903

13856 N Dale Mabry Hwy
Tampa, FL 33618-2420
Phone (813) 925-1903

16521 S US Hwy 301
TGH Urgent Care Powered by Fast Tra
Wimauma, FL 33598-2032
Phone (813) 928-1903

2810 W MLK Blvd
Tampa, FL 33607-6306
Phone (813) 925-1903

303 W Palm Ave
TGH Urgent Care Powered by Fast Tra
Tampa, FL 33602-2027
Phone (813) 925-1903

4505 Gunn Hwy
Tampa, FL 33624-6311
Phone (813) 925-1903

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9111768FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
Synergic Healthcare Solutions LLC CurrentSince Dec 1, 2018 Accepting new patients
Synergic Healthcare Solutions LLC Current Accepting new patients
Synergic Healthcare Solutions LLC CurrentSince Dec 1, 2018 Accepting new patients

Locations

3301 W Gandy Blvd
Tampa, FL 33611
Phone (318) 925-1903

5504 Gateway Blvd
Wesley Chapel, FL 33544
Phone (813) 948-5400

16521 US 301 S
Wimauma, FL 33598
Phone (813) 844-4700

200 N Bryant Ave
Ste 10
Edmond, OK 73034

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: mlastra159313@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1275009631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13134 EARLY RUN LN",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13134 EARLY RUN LN",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783387",
            "telephone_number": "813-481-8969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 W Gandy Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336112931",
            "country_code": "US",
            "telephone_number": "813-925-1903",
            "fax_number": "813-749-8370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LASTRA",
        "first_name": "MICHELLE",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-23",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9111768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130659300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "HINSON",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Riverview, FL

Sources for this page

Verify at the official NPI Registry.