Provider Demographics
NPI:1396439659
Name:COKE, TREVOR II
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:COKE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 CENTERGATE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7211
Mailing Address - Country:US
Mailing Address - Phone:954-892-7711
Mailing Address - Fax:
Practice Address - Street 1:2452 CENTERGATE DR APT 103
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7211
Practice Address - Country:US
Practice Address - Phone:954-892-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered