Provider Demographics
NPI:1518537133
Name:BALDA, TRISHA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARIE
Last Name:BALDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HUTTON PL
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-4953
Mailing Address - Country:US
Mailing Address - Phone:615-792-2223
Mailing Address - Fax:615-792-2792
Practice Address - Street 1:150 HUTTON PL
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-4953
Practice Address - Country:US
Practice Address - Phone:615-792-2223
Practice Address - Fax:615-792-2792
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN5246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program