Provider Demographics
NPI:1568591857
Name:TRIGOBOFF, NATHANIEL (EDD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:TRIGOBOFF
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:TRIGOBOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDDLIC SPECIALIST
Mailing Address - Street 1:10086 WEST MCNAB RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-597-9922
Mailing Address - Fax:413-375-4859
Practice Address - Street 1:10086 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1895
Practice Address - Country:US
Practice Address - Phone:954-597-9922
Practice Address - Fax:413-375-4859
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1836237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist