Provider Demographics
NPI:1417828971
Name:A BODY RENAISSANCE LLC
Entity type:Organization
Organization Name:A BODY RENAISSANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRINIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:385-501-1999
Mailing Address - Street 1:86 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2223
Mailing Address - Country:US
Mailing Address - Phone:385-501-1999
Mailing Address - Fax:801-206-3338
Practice Address - Street 1:86 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2223
Practice Address - Country:US
Practice Address - Phone:385-501-1999
Practice Address - Fax:801-206-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty