Provider Demographics
NPI:1609267343
Name:TRINA
Entity Type:Organization
Organization Name:TRINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-361-2812
Mailing Address - Street 1:1755 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-9717
Mailing Address - Country:US
Mailing Address - Phone:662-551-0189
Mailing Address - Fax:
Practice Address - Street 1:420 S GERMANTOWN PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4387
Practice Address - Country:US
Practice Address - Phone:901-682-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty