Provider Demographics
NPI:1972141497
Name:VAIL TRNKA, COLLEEN (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:VAIL TRNKA
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6748 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1912
Mailing Address - Country:US
Mailing Address - Phone:708-361-9701
Mailing Address - Fax:
Practice Address - Street 1:6748 W 111TH ST
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-1912
Practice Address - Country:US
Practice Address - Phone:708-361-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily