Healthcare Provider Details

I. General information

NPI: 1730774753
Provider Name (Legal Business Name): STEPHANIE TROCHE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TOWER RD NE STE 200
MARIETTA GA
30060-9412
US

IV. Provider business mailing address

400 TOWER RD NE STE 200
MARIETTA GA
30060-9412
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax: 770-999-2488
Mailing address:
  • Phone: 770-422-1372
  • Fax: 770-999-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-170235
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN231317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: