Provider Demographics
NPI:1083646210
Name:STANFORD, TRINETTE (CRNP)
Entity Type:Individual
Prefix:
First Name:TRINETTE
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 COUNTY ROAD 40
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310-3018
Mailing Address - Country:US
Mailing Address - Phone:334-585-5967
Mailing Address - Fax:334-673-4170
Practice Address - Street 1:2020 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3004
Practice Address - Country:US
Practice Address - Phone:334-673-4166
Practice Address - Fax:334-673-4170
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-075043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR77090Medicare UPIN