Provider Demographics
NPI:1104635473
Name:HALL, TRECIA JEAN (CNA)
Entity type:Individual
Prefix:
First Name:TRECIA
Middle Name:JEAN
Last Name:HALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 CORACI BLVD APT 7202
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7581
Mailing Address - Country:US
Mailing Address - Phone:352-718-4888
Mailing Address - Fax:
Practice Address - Street 1:5400 CORACI BLVD APT 7202
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7581
Practice Address - Country:US
Practice Address - Phone:352-718-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty