Provider Demographics
NPI:1386914141
Name:TRENT, DANIELLE DETESO (PA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:DETESO
Last Name:TRENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13530 LITTLE GEM CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7927
Mailing Address - Country:US
Mailing Address - Phone:239-677-7028
Mailing Address - Fax:
Practice Address - Street 1:5490 BRYSON DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0924
Practice Address - Country:US
Practice Address - Phone:239-596-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant