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General NPI Number Information
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NPI Number | 1275194409
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Entity Type | Individual
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Provider Name | JENNIFER RAE TROCK DNP, CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 5030 BRUNSON DR
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City | CORAL GABLES
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State | FL
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Zip | 33146-2412
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Country | US
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Telephone | 305-284-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 NE 188TH ST APT 2805
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City | AVENTURA
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State | FL
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Zip | 33180-2777
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Country | US
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Telephone | 440-796-7815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN9361313
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License Number State | FL
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