Provider Demographics
NPI:1114254695
Name:OGLETREE, TRINA (FNP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:OGLETREE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SUNNYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2946
Mailing Address - Country:US
Mailing Address - Phone:516-832-7100
Mailing Address - Fax:516-832-7160
Practice Address - Street 1:99 SUNNYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2946
Practice Address - Country:US
Practice Address - Phone:516-832-7100
Practice Address - Fax:516-832-7160
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily