Provider Demographics
NPI:1275194409
Name:TROCK, JENNIFER RAE (DNP, CRNA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:RAE
Last Name:TROCK
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 NE 188TH ST APT 2805
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2777
Mailing Address - Country:US
Mailing Address - Phone:440-796-7815
Mailing Address - Fax:
Practice Address - Street 1:5030 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2412
Practice Address - Country:US
Practice Address - Phone:305-284-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9361313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered