Healthcare Provider Details

I. General information

NPI: 1487281887
Provider Name (Legal Business Name): JESSICA RAE TRYGIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVENUE ML 5026
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3430 BURNET AVENUE ML 5026
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7722
  • Fax: 513-636-3737
Mailing address:
  • Phone: 513-636-7722
  • Fax: 513-636-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.148229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: