MEDICARE: TRISH ANN TRUBACHIK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA.11759-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336455930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISH ANN TRUBACHIK NP

Provider Business Mailing Address
First Line	:	700 N COLUMBUS ST
Second Line	:
City	:	CRESTLINE
State	:	OH
Zip	:	44827-1455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W MAIN ST
Second Line	:
City	:	NEW WASHINGTON
State	:	OH
Zip	:	44854-9431
Country	:	US
Telephone Number	:	419-462-4575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	01/08/2021

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