Healthcare Provider Details

I. General information

NPI: 1639864234
Provider Name (Legal Business Name): TRINITY CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 SAN IGNACIO DR
SEBRING FL
33872-1760
US

IV. Provider business mailing address

28 E MAIN ST UNIT 126
AVON PARK FL
33825-3943
US

V. Phone/Fax

Practice location:
  • Phone: 786-459-4226
  • Fax: 458-200-3014
Mailing address:
  • Phone: 786-459-4226
  • Fax: 458-200-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KETSIA AURELIEN
Title or Position: NURSE PRACTITIONER
Credential: A-GNP-C
Phone: 786-459-4226