Healthcare Provider Details

I. General information

NPI: 1679395958
Provider Name (Legal Business Name): TRINISHA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994-7204
US

IV. Provider business mailing address

6649 WOODS ISLAND CIR APT 106
PORT ST LUCIE FL
34952-1479
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax: 772-288-2999
Mailing address:
  • Phone: 772-288-2992
  • Fax: 772-288-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN9397526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: