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General NPI Number Information
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NPI Number | 1265804827
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Entity Type | Individual
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Provider Name | MERCEDES TRIMBLE B.S., M.ED
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Gender | Female
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 171 CANAL BLVD
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City | PONTE VEDRA
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State | FL
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Zip | 32082-3607
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Country | US
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Telephone | 904-834-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 280 HUNTERS LAKE WAY APT 4301
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0185
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Country | US
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Telephone | 321-205-5663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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