Provider Demographics
NPI:1063126191
Name:TRIFONOVA, MARIYA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:TRIFONOVA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD ST STE 702
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6989
Mailing Address - Country:US
Mailing Address - Phone:410-334-2227
Mailing Address - Fax:
Practice Address - Street 1:106 MILFORD ST STE 702
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6989
Practice Address - Country:US
Practice Address - Phone:410-334-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily