Provider Demographics
NPI:1952746950
Name:TROSS, ANNETTE T (MSN, CRNP, NP-C)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:T
Last Name:TROSS
Suffix:
Gender:F
Credentials:MSN, CRNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 RIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 LINDEN ST
Practice Address - Street 2:UNIVERSITY OF SCRANTON STUDENT HEALTH SERVICES
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2429
Practice Address - Country:US
Practice Address - Phone:570-941-7667
Practice Address - Fax:570-941-4298
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005746B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner