Healthcare Provider Details

I. General information

NPI: 1073978359
Provider Name (Legal Business Name): RENISSE TRECIA TRILLANA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N LOGAN ST STE 660
DENVER CO
80203-1994
US

IV. Provider business mailing address

91-1780 KOHANAHANA LOOP
EWA BEACH HI
96706-7851
US

V. Phone/Fax

Practice location:
  • Phone: 866-968-3694
  • Fax: 844-749-3705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-1129
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61342922
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.2812
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: