Healthcare Provider Details

I. General information

NPI: 1144555608
Provider Name (Legal Business Name): TRENA YOUNGLOVE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7821 PINE MARSH CT
ORLANDO FL
32819-7130
US

IV. Provider business mailing address

7821 PINE MARSH CT
ORLANDO FL
32819-7130
US

V. Phone/Fax

Practice location:
  • Phone: 407-903-0810
  • Fax:
Mailing address:
  • Phone: 407-903-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: