Provider Demographics
NPI:1639864234
Name:TRINITY CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:TRINITY CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KETSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AURELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:A-GNP-C
Authorized Official - Phone:786-459-4226
Mailing Address - Street 1:5089 SAN IGNACIO DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1760
Mailing Address - Country:US
Mailing Address - Phone:786-459-4226
Mailing Address - Fax:
Practice Address - Street 1:5089 SAN IGNACIO DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1760
Practice Address - Country:US
Practice Address - Phone:786-459-4226
Practice Address - Fax:458-200-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty