Provider Demographics
NPI:1376894469
Name:BOYCE, TRINA DANETTE (ANP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:DANETTE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:ANP
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 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:6824 HARRISBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3389
Practice Address - Country:US
Practice Address - Phone:704-870-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006167A363LA2200X
NC5017155363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006557Medicaid
SCSC03237981Medicare PIN
SCSC03234784Medicare PIN
SCSC03231849Medicare PIN
SCSC03231850Medicare PIN
SCSC03237977Medicare PIN