Provider Demographics
NPI:1417510264
Name:TREVINO, DESTINY JOY (FNP-C)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:JOY
Last Name:TREVINO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 FLAGG RANCH DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-2618
Mailing Address - Country:US
Mailing Address - Phone:832-638-3439
Mailing Address - Fax:
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-559-6441
Practice Address - Fax:281-817-1179
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX865234163W00000X
TXAP142076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse