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General NPI Number Information
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NPI Number | 1548594492
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Entity Type | Individual
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Provider Name | TRUSHA PATEL PA
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Gender | Female
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 950 FRIST STREET SOUTH
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-595-1360
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Fax |
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Provider Business Mailing Address
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Address Line | 5261 ENGLISH DR
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City | LAKELAND
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State | FL
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Zip | 33812-4479
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Country | US
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Telephone | 630-440-2160
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-003565
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License Number State | IL
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