MEDICARE: ABIMBOLA A. TREPANIER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024180629	VA

General Provider Information

NPI Number	:	1285230615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIMBOLA A. TREPANIER FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1871
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-1871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 E PARHAM RD STE 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2234
Country	:	US
Telephone Number	:	240-486-1757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	10/09/2023

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