Provider Demographics
NPI:1265838932
Name:GILL, TRISHA (NP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 LAKEWOOD RD STE 16
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:731-456-7777
Mailing Address - Fax:848-251-2189
Practice Address - Street 1:1536 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:848-251-2189
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00915300363LF0000X, 207N00000X
PASP016264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4885561OtherAETNA
PA30254076OtherAMERIHEALTH CARITAS
PA1224874OtherGATEWAY
PA773933OtherMEDICARE PTAN
PA103270049Medicaid