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General NPI Number Information
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NPI Number | 1831620681
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Entity Type | Individual
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Provider Name | DESIREE TRAINA M.A
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Gender | Female
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 7406 FULLERTON ST 200
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3552
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Country | US
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Telephone | 904-538-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PUTTER DR
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City | PALM COAST
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State | FL
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Zip | 32164-7404
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Country | US
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Telephone | 904-607-0223
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | CNA300372
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License Number State | FL
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