Healthcare Provider Details

I. General information

NPI: 1316341746
Provider Name (Legal Business Name): ANA C TRISAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE SUITE 6008
MIAMI FL
33133-4227
US

IV. Provider business mailing address

15051 S TAMIAMI TRL SUITE 203
FORT MYERS FL
33908-5182
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-6555
  • Fax: 305-856-6556
Mailing address:
  • Phone: 239-232-1180
  • Fax: 239-313-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: