Provider Demographics
NPI:1114417847
Name:TROCOLA, JENNIFER LYNN (AGACNP-BC, ACHPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:TROCOLA
Suffix:
Gender:F
Credentials:AGACNP-BC, ACHPN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC, ACHPN
Mailing Address - Street 1:63 MYANO LN APT 6
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4500
Mailing Address - Country:US
Mailing Address - Phone:845-532-7548
Mailing Address - Fax:
Practice Address - Street 1:63 MYANO LN APT 6
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4500
Practice Address - Country:US
Practice Address - Phone:845-532-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7375363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care