Provider Demographics
NPI:1477951572
Name:TRINIDAD, RODELINE V (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:RODELINE
Middle Name:V
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 S JONES BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-7125
Mailing Address - Country:US
Mailing Address - Phone:702-880-4193
Mailing Address - Fax:702-880-4197
Practice Address - Street 1:7175 N DURANGO DR
Practice Address - Street 2:SUITE 230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4479
Practice Address - Country:US
Practice Address - Phone:702-880-4193
Practice Address - Fax:702-645-4009
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily