Provider Demographics
NPI:1871307868
Name:TRENT-WEEKLEY, JONATHON DALE
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:DALE
Last Name:TRENT-WEEKLEY
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 1:6118 51ST AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3526
Mailing Address - Country:US
Mailing Address - Phone:727-510-4745
Mailing Address - Fax:
Practice Address - Street 1:6500 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1629
Practice Address - Country:US
Practice Address - Phone:727-384-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9273462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered