Provider Demographics
NPI:1073978359
Name:TRILLANA, RENISSE TRECIA (PA)
Entity type:Individual
Prefix:
First Name:RENISSE TRECIA
Middle Name:
Last Name:TRILLANA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1780 KOHANAHANA LOOP
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-7851
Mailing Address - Country:US
Mailing Address - Phone:919-820-9969
Mailing Address - Fax:
Practice Address - Street 1:590 FARRINGTON HWY UNIT 526A
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2034
Practice Address - Country:US
Practice Address - Phone:808-762-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61342922363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2292214Medicaid