Healthcare Provider Details

I. General information

NPI: 1336893650
Provider Name (Legal Business Name): TRISSA RHEA GUSTOVICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4450
  • Fax: 724-830-6669
Mailing address:
  • Phone: 724-832-4450
  • Fax: 724-830-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024758
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: