Provider Demographics
NPI:1558677120
Name:BOYLES, TRINA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:
Last Name:BOYLES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:TRINA
Other - Middle Name:
Other - Last Name:POPEJOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2326
Mailing Address - Country:US
Mailing Address - Phone:269-659-4448
Mailing Address - Fax:
Practice Address - Street 1:1555 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1993
Practice Address - Country:US
Practice Address - Phone:269-651-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704195097OtherRN
MI4704195097OtherNURSE PRACTITIONER
F0710369OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS