Provider Demographics
NPI:1689291726
Name:FRIAR, TREVON JARROD (NP)
Entity Type:Individual
Prefix:MR
First Name:TREVON
Middle Name:JARROD
Last Name:FRIAR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11412 ACACIA GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-8412
Mailing Address - Country:US
Mailing Address - Phone:386-299-0045
Mailing Address - Fax:
Practice Address - Street 1:11968 BALM RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6601
Practice Address - Country:US
Practice Address - Phone:813-819-3335
Practice Address - Fax:866-885-1512
Is Sole Proprietor?:No
Enumeration Date:2020-07-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007913363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108148000Medicaid