Provider Demographics
NPI:1821711722
Name:PERCENTIE, TREVINA
Entity Type:Individual
Prefix:
First Name:TREVINA
Middle Name:
Last Name:PERCENTIE
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 1:109 AMBERSWEET WAY # 240
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8418
Mailing Address - Country:US
Mailing Address - Phone:954-931-4602
Mailing Address - Fax:
Practice Address - Street 1:3370 BEAU RIVAGE DR APT E2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2045
Practice Address - Country:US
Practice Address - Phone:954-931-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238620376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty