Provider Demographics
NPI:1508412644
Name:DEMETRIUS, TRISCHADAY KIMBERLEY (APRN)
Entity Type:Individual
Prefix:MS
First Name:TRISCHADAY
Middle Name:KIMBERLEY
Last Name:DEMETRIUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD CANOE CREEK RD # 702019
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1400
Mailing Address - Country:US
Mailing Address - Phone:407-791-8732
Mailing Address - Fax:
Practice Address - Street 1:4701 OLD CANOE CREEK RD # 702019
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1400
Practice Address - Country:US
Practice Address - Phone:407-791-8732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner