MEDICARE: CORINNE HELENA TRUSOCK PA-C

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	363A00000X	Physician Assistant	9564	GA
2	363A00000X	Physician Assistant	5601003291	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970020813	OTHER	MI	RAILROAD RETIREMENT
2	G86360	OTHER	MA	PRIORITY HEALTH

General Provider Information

NPI Number	:	1780738823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE HELENA TRUSOCK PA-C

Provider Business Mailing Address
First Line	:	3800 S OCEAN DR STE 209
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2915
Country	:	US
Telephone Number	:	305-466-9988
Fax Number	:	305-466-9989

Provider Business Practice Location Address
First Line	:	QSM-GA, INC-SNF
Second Line	:	1821 ANDERSON AVE NW
City	:	ATLANTA
State	:	GA
Zip	:	33014-1835
Country	:	US
Telephone Number	:	305-466-9988
Fax Number	:	305-466-9989

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	03/25/2020

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