Healthcare Provider Details

I. General information

NPI: 1831620681
Provider Name (Legal Business Name): DESIREE TRAINA M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 FULLERTON ST 200
JACKSONVILLE FL
32256-3552
US

IV. Provider business mailing address

75 PUTTER DR
PALM COAST FL
32164-7404
US

V. Phone/Fax

Practice location:
  • Phone: 904-538-0440
  • Fax:
Mailing address:
  • Phone: 904-607-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberCNA300372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: