Healthcare Provider Details

I. General information

NPI: 1053021931
Provider Name (Legal Business Name): TRENTON MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 RANCHERA STREET NW
LIVE OAK FL
32064
US

IV. Provider business mailing address

23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US

V. Phone/Fax

Practice location:
  • Phone: 386-364-1751
  • Fax:
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANITA H. REMBERT
Title or Position: CEO
Credential:
Phone: 352-463-4501