Healthcare Provider Details

I. General information

NPI: 1164162822
Provider Name (Legal Business Name): HEATHER TREVINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19875 SW 65TH AVE STE 100
TUALATIN OR
97062-8353
US

IV. Provider business mailing address

PO BOX 6689
PORTLAND OR
97228-6689
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-7785
  • Fax:
Mailing address:
  • Phone: 562-400-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95018411
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10034239
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: