Healthcare Provider Details

I. General information

NPI: 1477481653
Provider Name (Legal Business Name): TRITON GLOBAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17020 SW 149TH AVE
MIAMI FL
33187-6751
US

IV. Provider business mailing address

17020 SW 149TH AVE
MIAMI FL
33187-6751
US

V. Phone/Fax

Practice location:
  • Phone: 810-423-9708
  • Fax: 810-423-9708
Mailing address:
  • Phone: 810-423-9708
  • Fax: 810-423-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONOVON NATHANIEL COOLEY
Title or Position: OWNER
Credential:
Phone: 810-423-9708