Healthcare Provider Details

I. General information

NPI: 1124445176
Provider Name (Legal Business Name): TRINA CAUGHMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 HIGHWAY 178
SWANSEA SC
29160-8649
US

IV. Provider business mailing address

2221 HIGHWAY 178
SWANSEA SC
29160-8649
US

V. Phone/Fax

Practice location:
  • Phone: 803-568-2314
  • Fax:
Mailing address:
  • Phone: 803-568-2314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number22187
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: