Healthcare Provider Details

I. General information

NPI: 1518330901
Provider Name (Legal Business Name): TIMOTHY CHARLES TROTTER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W CHESTER PIKE
WEST CHESTER PA
19382-5005
US

IV. Provider business mailing address

500 KIRTS BLVD STE 100
TROY MI
48084-4135
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-3636
  • Fax: 610-918-0142
Mailing address:
  • Phone: 248-434-6169
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015460
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: