Healthcare Provider Details

I. General information

NPI: 1518676329
Provider Name (Legal Business Name): TRIDENT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 N WICKHAM RD STE 101
MELBOURNE FL
32940-8096
US

IV. Provider business mailing address

7960 N WICKHAM RD STE 101
MELBOURNE FL
32940-8096
US

V. Phone/Fax

Practice location:
  • Phone: 321-364-2822
  • Fax: 321-364-2844
Mailing address:
  • Phone: 321-508-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMARA A EDELSTEIN-SNIDER
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 321-364-2822