Basic Information
| Provider Information | |||||||||
| NPI: | 1003001686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROST | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142518015 | ||||||||
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| 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: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | COA09545 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | ARNP9337862 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LN0000X | APRN.CNP.09545 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
| ID | Type | State | Issuer | Description | 2834302 | 05 | OH | MEDICAID | 015224300 | 05 | FL | MEDICAID | NP82171 | 05 | OH | MEDICAID | Y0R0N | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |