Provider Demographics
NPI:1841278108
Name:TRIGLETH, JAN LEE (PA)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:LEE
Last Name:TRIGLETH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:380 N RESERVATION RD
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2316
Mailing Address - Fax:559-781-6514
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:559-791-2589
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant