MEDICARE: MS. TRINA NOBLES MCMILLAN APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN102265	GA

General Provider Information

NPI Number	:	1265636096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRINA NOBLES MCMILLAN APRN, FNP-C

Provider Business Mailing Address
First Line	:	977 WAYNE POULTRY RD
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-3915
Country	:	US
Telephone Number	:	706-405-3799
Fax Number	:	706-749-7954

Provider Business Practice Location Address
First Line	:	977 WAYNE POULTRY RD
Second Line	:
City	:	PENDERGRASS
State	:	GA
Zip	:	30567-3915
Country	:	US
Telephone Number	:	706-405-3799
Fax Number	:	706-749-7954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/23/2020

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