Provider Demographics
NPI:1891006045
Name:ENTELISANO, TRINA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:MARIE
Last Name:ENTELISANO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:MARIE
Other - Last Name:BALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5510 SW 41ST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:855-297-8326
Mailing Address - Fax:888-503-7832
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:522-650-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9221896363LA2100X
FL92218962086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002749500Medicaid
FLDR289ZMedicare PIN