MEDICARE: TRIDENT HEALTHCARE LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1518676329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIDENT HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	7960 N WICKHAM RD STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8096
Country	:	US
Telephone Number	:	321-508-2343
Fax Number	:

Provider Business Practice Location Address
First Line	:	7960 N WICKHAM RD STE 101
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8096
Country	:	US
Telephone Number	:	321-364-2822
Fax Number	:	321-364-2844

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TAMARA A EDELSTEIN-SNIDER
Credential	:	NURSE PRACTITIONER
Telephone Number	:	321-364-2822

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	03/03/2026

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Directions to “TRIDENT HEALTHCARE LLC ” Practice Location

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