Healthcare Provider Details

I. General information

NPI: 1033906557
Provider Name (Legal Business Name): JUSIN TROELSTRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 SLIGH BLVD STE 200
ORLANDO FL
32806
US

IV. Provider business mailing address

1335 SLIGH BLVD STE 400 MP 100
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6884
  • Fax:
Mailing address:
  • Phone: 321-841-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: