Provider Demographics
NPI:1407680671
Name:WARGO, TRENTON CHRISTOPHER JEFFREY
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:CHRISTOPHER JEFFREY
Last Name:WARGO
Suffix:
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 1:316 BLUEWATER FALLS CT
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3101
Mailing Address - Country:US
Mailing Address - Phone:724-931-2134
Mailing Address - Fax:
Practice Address - Street 1:2902 59TH ST W STE C
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7021
Practice Address - Country:US
Practice Address - Phone:941-877-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty