Provider Demographics
NPI:1376894469
Name:BOYCE, TRINA DANETTE (ANP)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:DANETTE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:1814 WESTCHESTER DR STE 203
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2489
Practice Address - Fax:336-802-2026
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006167A363LA2200X
NC5017155363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006557Medicaid
SCSC03237981Medicare PIN
SCSC03234784Medicare PIN
SCSC03231849Medicare PIN
SCSC03231850Medicare PIN
SCSC03237977Medicare PIN