Healthcare Provider Details

I. General information

NPI: 1760832943
Provider Name (Legal Business Name): TRINA ALLEMOND ORTEGO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

IV. Provider business mailing address

2949 S UNION ST
OPELOUSAS LA
70570-5740
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-9606
  • Fax:
Mailing address:
  • Phone: 337-948-9606
  • Fax: 337-948-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08802
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08802
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: