Provider Demographics
NPI:1376987610
Name:FORNEY, TRINA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:
Last Name:FORNEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 PINE BLUFF RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7163
Mailing Address - Country:US
Mailing Address - Phone:410-742-5599
Mailing Address - Fax:410-742-4873
Practice Address - Street 1:201 PINE BLUFF RD
Practice Address - Street 2:SUITE 28
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7163
Practice Address - Country:US
Practice Address - Phone:410-742-5599
Practice Address - Fax:410-742-4873
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR125020363L00000X
DELG0000676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG0000676OtherSTATE OF DELAWARE
MDR125020OtherSTATE OF MARYLAND