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General NPI Number Information
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NPI Number | 1518917798
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Entity Type | Individual
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Provider Name | TRINA DESIREE LANZA RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/20/2021
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Provider Practice Location Address
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Address Line | 3549 HIGH TIMBER DR.
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 682-521-2295
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Fax | 682-521-2295
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Provider Business Mailing Address
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Address Line | PO BOX 1336
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City | COLLEYVILLE
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State | TX
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Zip | 76034
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Country | US
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Telephone | 682-521-2295
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 583243
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP114312
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License Number State | TX
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