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Individual
TREVOR FREDERICK EZZELL
Active
Individual
TREVOR FREDERICK EZZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN152048
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01228809
AMERIGROUP
GA
05
—
129681407A
—
GA
05
—
129681407B
—
GA
05
—
129681407C
—
GA
01
—
462656
WELLCARE
GA
01
—
P00903614
MEDICARE RAILROAD
GA
Enumeration date
07/10/2008
Last updated
02/20/2012
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