Provider Demographics
NPI:1447603139
Name:TROST, JENNIFER (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TROST
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 N WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0809
Mailing Address - Country:US
Mailing Address - Phone:781-999-1189
Mailing Address - Fax:
Practice Address - Street 1:7206 N MILBURN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8450
Practice Address - Country:US
Practice Address - Phone:559-224-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant