Provider Demographics
NPI:1558831156
Name:TRINIDAD, WENDY
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15074 MOUNT IVY RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-1360
Mailing Address - Country:US
Mailing Address - Phone:941-303-7724
Mailing Address - Fax:
Practice Address - Street 1:15074 MOUNT IVY RD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-1360
Practice Address - Country:US
Practice Address - Phone:941-303-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237246372600000X, 376J00000X
253Z00000X
FLG18000124380376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237246OtherHEALTH CARE ADMINISTRATION