Provider Demographics
NPI:1346893732
Name:TROMBATORE, JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TROMBATORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:
Other - Last Name:TROMBATORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 123594 DEPT 3594
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:4345 NELSON RD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4183
Practice Address - Country:US
Practice Address - Phone:337-480-7999
Practice Address - Fax:337-602-6358
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily