Healthcare Provider Details

I. General information

NPI: 1194101675
Provider Name (Legal Business Name): TRINITY CATHERINE GRAHAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINITY PANCAKE

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SARNO RD
MELBOURNE FL
32935-3084
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6800
  • Fax: 321-241-6890
Mailing address:
  • Phone: 321-952-9696
  • Fax: 321-952-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9332727
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9332727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: