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General NPI Number Information
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NPI Number | 1912733841
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Entity Type | Organization
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Legal Business Name | TRINOVA HEALTHCARE LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2114 CREIGHTON RD
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City | PENSACOLA
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State | FL
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Zip | 32504-7218
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Country | US
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Telephone | 850-332-3740
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Fax | 850-429-4813
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Provider Business Mailing Address
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Address Line | 2114 CREIGHTON RD
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City | PENSACOLA
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State | FL
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Zip | 32504-7218
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Country | US
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Telephone | 850-848-9500
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Fax | 850-901-0009
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARK MCGRATH RYAN
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Credential | MD
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Telephone | 850-848-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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