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Individual
TRINA NICOLE RAVENELL
Active
Individual
TRINA NICOLE RAVENELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2783
SC
363AM0700X
Medical Physician Assistant
MPA2783TL
SC
363AM0700X
Medical Physician Assistant
TL2783
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3026PA
—
SC
01
—
MPA2783TL
SC BOARD OF MEDICAL EXAMINERS
SC
01
—
SCA853
MEDICARE
SC
Enumeration date
07/12/2017
Last updated
11/24/2021
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