Provider Demographics
NPI:1831816842
Name:COOKE, TREVIKA SUSAN (CNM)
Entity type:Individual
Prefix:MS
First Name:TREVIKA
Middle Name:SUSAN
Last Name:COOKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-8201
Mailing Address - Country:US
Mailing Address - Phone:754-235-9826
Mailing Address - Fax:
Practice Address - Street 1:3200 NW 33RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-8201
Practice Address - Country:US
Practice Address - Phone:754-235-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022400367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife