Provider Demographics
NPI:1447720362
Name:TROSSMAN, NOLA (ARNP)
Entity type:Individual
Prefix:MS
First Name:NOLA
Middle Name:
Last Name:TROSSMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NOLA
Other - Middle Name:
Other - Last Name:COUGHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5155 WILDEN RD
Mailing Address - Street 2:
Mailing Address - City:MICCO
Mailing Address - State:FL
Mailing Address - Zip Code:32976-2728
Mailing Address - Country:US
Mailing Address - Phone:321-298-6549
Mailing Address - Fax:
Practice Address - Street 1:1335 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3127
Practice Address - Country:US
Practice Address - Phone:321-586-5444
Practice Address - Fax:321-319-9712
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9198165Medicaid