Provider Demographics
NPI:1245426394
Name:TRINIDAD, JENNIFER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 HILLIARD ROME OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7287
Mailing Address - Country:US
Mailing Address - Phone:614-636-3668
Mailing Address - Fax:614-363-4723
Practice Address - Street 1:5539 HILLIARD ROME OFFICE PARK
Practice Address - Street 2:SUITE #120
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7287
Practice Address - Country:US
Practice Address - Phone:614-636-3668
Practice Address - Fax:614-363-4723
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003541213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3085085Medicaid
OH4301011Medicare PIN
OH7536600001Medicare NSC
OHP01385746Medicare PIN