Healthcare Provider Details

I. General information

NPI: 1760829063
Provider Name (Legal Business Name): TRICIA A KOCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

8704 EAGLE VIEW DR
DURHAM NC
27713-5917
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-5136
  • Fax:
Mailing address:
  • Phone: 330-354-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number92664
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3063
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: