Provider Demographics
NPI:1659941615
Name:TREMBLAY, ELISSA IRENE (FNP)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:IRENE
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NORTHPORT AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6069
Mailing Address - Country:US
Mailing Address - Phone:207-505-4567
Mailing Address - Fax:
Practice Address - Street 1:119 NORTHPORT AVE FL 1
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6069
Practice Address - Country:US
Practice Address - Phone:207-505-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily