Provider Demographics
NPI:1356594022
Name:GOMM, TRINA S
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:S
Last Name:GOMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:S
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2110 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-8400
Mailing Address - Country:US
Mailing Address - Phone:928-348-2151
Mailing Address - Fax:
Practice Address - Street 1:1492 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4052
Practice Address - Country:US
Practice Address - Phone:928-348-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152502163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool