Basic Information
| Provider Information | |||||||||
| NPI: | 1144707183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROUP | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | APRN FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 SE MAGNOLIA EXT UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344713770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011218 | ||||||||
| FaxNumber: | 3524011017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1234 SE MAGNOLIA EXT UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344713770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011218 | ||||||||
| FaxNumber: | 3524011017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APRN9374283 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LP0200X | APRN9374283 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363L00000X | APRN9374283 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 104078500 | 05 | FL | MEDICAID |