Provider Demographics
NPI:1063934727
Name:TROXELL, ELYSE CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:CHRISTINE
Last Name:TROXELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COLLEGE PL APT 121
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-0915
Mailing Address - Country:US
Mailing Address - Phone:570-850-3579
Mailing Address - Fax:
Practice Address - Street 1:201 COLLEGE PL APT 121
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-0915
Practice Address - Country:US
Practice Address - Phone:570-850-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant