Healthcare Provider Details

I. General information

NPI: 1326549809
Provider Name (Legal Business Name): TRENA RIOS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MAR WALT DR UNIT C
FORT WALTON BEACH FL
32547
US

IV. Provider business mailing address

12301 SAINT CLAIR DR
LOUISVILLE KY
40243-1028
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax:
Mailing address:
  • Phone: 502-338-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30112081
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9493489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: