Provider Demographics
NPI:1316341746
Name:TRISAN, ANA C (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:C
Last Name:TRISAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:15051 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5182
Mailing Address - Country:US
Mailing Address - Phone:239-232-1180
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:SUITE 6008
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-856-6555
Practice Address - Fax:305-856-6556
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2017-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant