Provider Demographics
NPI:1265859433
Name:RYAN, TRINA ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:ELAINE
Last Name:RYAN
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-422-0213
Mailing Address - Fax:731-686-8997
Practice Address - Street 1:4039 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3483
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-686-8997
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN18589OtherADVANCE PRACTICE STATE LICENSE
TNRN0000101400OtherSTATE LICENSE