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TRIDENT PRIMARY & PREVENTATIVE CARE
NPI 1023574696
Family Medicine in Fort Lauderdale, FL

Active since February 19, 2019
800 E BROWARD BLVD STE 400, FORT LAUDERDALE, FL 33301(954) 451-5454 Get Directions Write a Review

NPPES record last updated: August 26, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 26, 2019, Feb 19, 2019 (2 updates tracked since 2019).

About Trident Primary & Preventative Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRIDENT PRIMARY & PREVENTATIVE CARE (NPI 1023574696) is a healthcare organization registered as a family medicine in Fort Lauderdale, Florida and active in the NPI registry since February 2019. The organization lists John Poulos, Owner, as its authorized official.

NPPES Registry Identity

NPI1023574696
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTRIDENT ANTI AGING, LLC
Location Address800 E BROWARD BLVD STE 400Fort Lauderdale, FL 33301-2033
Mailing Address800 E Broward Blvd Ste 400Fort Lauderdale, FL 33301-2033 · (954) 451-5454
Phone(954) 451-5454
Organization SubpartNo
Authorized OfficialJohn PoulosOwner · (954) 451-5454
Enumeration DateFebruary 19, 2019
Last NPPES UpdateAugust 26, 20192 updates tracked since enumeration
✔ NPI 1023574696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
800 E BROWARD BLVD STE 400, Fort Lauderdale, FL 33301
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Other Names 1

Doing Business AsTrident Primary & Preventative Care

Other Identifiers 2

Medicaid1750407086FL
Medicaid1750716387GA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROCHELLE CHRISTINE DELA PAZ D.C., APRN
Nurse Practitioner
800 E BROWARD BLVD STE 400
FORT LAUDERDALE, FL 33301
Broward County (954) 451-5454
MS. LORI ANN JESBERGER NP-C
Nurse Practitioner (Primary Care)
800 E BROWARD BLVD STE 400
FORT LAUDERDALE, FL 33301
Broward County (419) 668-4851

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Trident Anti Aging, LLC's NPI number?

The NPI number for Trident Anti Aging, LLC is 1023574696. It was assigned to this organization in the NPPES registry on February 19, 2019. The provider is doing business as Trident Primary & Preventative Care.

Where is Trident Anti Aging, LLC located?

Trident Anti Aging, LLC is located at 800 E Broward Blvd Ste 400, Fort Lauderdale, FL 33301. The listed phone number is (954) 451-5454.

What is Trident Anti Aging, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Trident Anti Aging, LLC was last updated on August 26, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.