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General NPI Number Information
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NPI Number | 1699774034
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Entity Type | Individual
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Provider Name | JASON KENNETH TRIGIANI PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 730 STONY LANDING RD
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City | MONCKS CORNER
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State | SC
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Zip | 29461-2904
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Country | US
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Telephone | 800-846-7707
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Fax | 843-899-7885
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Provider Business Mailing Address
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Address Line | PO BOX 601495
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City | CHARLOTTE
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State | NC
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Zip | 28260-1495
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Country | US
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Telephone | 843-789-1620
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Fax | 843-724-2454
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | A674
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | A674
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 674
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License Number State | SC
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