MEDICARE: MRS. CYNTHIA N TRENT CPNP, AE-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	363LP0200X	Pediatric Nurse Practitioner	0024127248	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609870625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA N TRENT CPNP, AE-C

Provider Business Mailing Address
First Line	:	1212 LAKE JAMES DR
Second Line	:	SUITE C
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6779
Country	:	US
Telephone Number	:	757-523-4589
Fax Number	:	757-523-8920

Provider Business Practice Location Address
First Line	:	1212 LAKE JAMES DR
Second Line	:	SUITE C
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6779
Country	:	US
Telephone Number	:	757-523-4589
Fax Number	:	757-523-8920

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	09/21/2012

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