Provider Demographics
NPI:1730178344
Name:TRENT, LINDA DIANE (FNP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:TRENT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5675 CENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8613
Mailing Address - Country:US
Mailing Address - Phone:662-895-8377
Mailing Address - Fax:
Practice Address - Street 1:9075 SANDIDGE CENTER COVE
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-895-4949
Practice Address - Fax:662-895-6776
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR786571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS95062Medicare UPIN