Provider Demographics
NPI:1346760675
Name:DMYTRUK, TRISHA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:ANN
Last Name:DMYTRUK
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:12615 KANE ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3753
Mailing Address - Country:US
Mailing Address - Phone:704-947-7925
Mailing Address - Fax:704-316-6773
Practice Address - Street 1:11840 SOUTHMORE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4821
Practice Address - Country:US
Practice Address - Phone:704-316-4440
Practice Address - Fax:704-316-4441
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCDMYT-D80B68207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics