Provider Demographics
NPI:1629663323
Name:GASTON, TRINA
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:GASTON
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 1:7349 BIRCH CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-0047
Mailing Address - Country:US
Mailing Address - Phone:334-453-2353
Mailing Address - Fax:
Practice Address - Street 1:7349 BIRCH CREEK TRL
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-0047
Practice Address - Country:US
Practice Address - Phone:334-453-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189548363LF0000X
AL1-162201363LF0000X
MARN2367985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA927683OtherNY RN LICENSE
AL2-041686OtherAL RN LICENSE
MARN2367985OtherRN MA LICENSE
VA0024189548OtherLICENSE -CRNP