Provider Demographics
NPI:1841639812
Name:HENDERSON, TRINA CARINE (FNP-C)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:CARINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 WOODRUFF RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5959
Mailing Address - Country:US
Mailing Address - Phone:480-228-1741
Mailing Address - Fax:
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:864-442-4110
Practice Address - Fax:864-442-4126
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN126277363LF0000X
SC19471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily