MEDICARE: MRS. DANIELLE DETESO TRENT P.A

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	363A00000X	Physician Assistant	PA9106300	FL

General Provider Information

NPI Number	:	1386914141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE DETESO TRENT P.A

Provider Business Mailing Address
First Line	:	13530 LITTLE GEM CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7927
Country	:	US
Telephone Number	:	239-677-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	5490 BRYSON DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0924
Country	:	US
Telephone Number	:	239-596-7731
Fax Number	:

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

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/10/2012

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