Provider Demographics
NPI:1073978359
Name:TRILLANA, RENISSE TRECIA (PA)
Entity Type:Individual
Prefix:
First Name:RENISSE TRECIA
Middle Name:
Last Name:TRILLANA
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-783-4888
Mailing Address - Fax:919-783-4887
Practice Address - Street 1:2601 LAKE DR STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-783-4888
Practice Address - Fax:919-783-4887
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2018-07-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant