Provider Demographics
NPI:1396387148
Name:TINDALL, TRINITY E
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:E
Last Name:TINDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRINITY
Other - Middle Name:E
Other - Last Name:HULST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1316 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1835
Mailing Address - Country:US
Mailing Address - Phone:231-739-9461
Mailing Address - Fax:
Practice Address - Street 1:1316 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1891
Practice Address - Country:US
Practice Address - Phone:231-739-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant