Basic Information
Provider Information
NPI: 1003001686
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TROST
FirstName: JENNIFER
MiddleName: DAWN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2200 JEFFERSON AVE
Address2: 5TH FLOOR
City: TOLEDO
State: OH
PostalCode: 436047101
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2213 CHERRY ST
Address2:  
City: TOLEDO
State: OH
PostalCode: 436082603
CountryCode: US
TelephoneNumber: 4192514360
FaxNumber: 4192515117
Other Information
ProviderEnumerationDate: 09/07/2007
LastUpdateDate: 02/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XARNP9337862FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000XCOA09545OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
Y0R0N01FLBLUE CROSS BLUE SHIELDOTHER
283430205OH MEDICAID
01522430005FL MEDICAID
NP8217105OH MEDICAID


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