Provider Demographics
NPI:1518917798
Name:LANZA, TRINA DESIREE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:DESIREE
Last Name:LANZA
Suffix:
Gender:F
Credentials:RN, FNP
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 1336
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:682-521-2295
Mailing Address - Fax:
Practice Address - Street 1:3549 HIGH TIMBER DR.
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:682-521-2295
Practice Address - Fax:682-521-2295
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583243363LF0000X
TXAP114312363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177844105Medicaid
TX177844103Medicaid
TX177844104Medicaid
TXTXB105312Medicare PIN
TX177844104Medicaid
TXTXB105316Medicare PIN
TXTXB105311Medicare PIN