Healthcare Provider Details

I. General information

NPI: 1659436210
Provider Name (Legal Business Name): JENNIFER JACOBSEN TROTTE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 WILLOW GROVE ST
HACKETTSTOWN NJ
07840-1799
US

IV. Provider business mailing address

13 INDIAN SPRING RD
BUDD LAKE NJ
07828-1903
US

V. Phone/Fax

Practice location:
  • Phone: 908-850-6727
  • Fax:
Mailing address:
  • Phone: 973-347-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO11634400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: