Provider Demographics
NPI:1932259371
Name:ST ANN, TRINA DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:DENISE
Last Name:ST ANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 FM 1103 STE 125
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3673
Mailing Address - Country:US
Mailing Address - Phone:210-888-1175
Mailing Address - Fax:210-888-0042
Practice Address - Street 1:791 FM 1103 STE 125
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3673
Practice Address - Country:US
Practice Address - Phone:218-888-1175
Practice Address - Fax:210-888-0042
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378783YKQQMedicare PIN