Provider Demographics
NPI:1932307592
Name:TRENT HAMRICK, LEONA (PA-C)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:TRENT HAMRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4752
Mailing Address - Country:US
Mailing Address - Phone:727-244-6411
Mailing Address - Fax:
Practice Address - Street 1:1615 SUMMIT WAY
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4752
Practice Address - Country:US
Practice Address - Phone:727-244-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101855363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
E7667XOtherPTAN
PA9101855OtherLICENSE
FLE7667VMedicare PIN