Provider Demographics
NPI:1366562365
Name:THORP, JANNINE MARIE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:JANNINE
Middle Name:MARIE
Last Name:THORP
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JANNINE
Other - Middle Name:MARIE
Other - Last Name:TRUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:301 EAST MAIN ST
Mailing Address - Street 2:SOUTHSIDE HOSPITAL
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:613-968-3525
Mailing Address - Fax:631-968-3022
Practice Address - Street 1:301 EAST MAIN ST
Practice Address - Street 2:SOUTHSIDE HOSPITAL
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:613-968-3525
Practice Address - Fax:631-968-3022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010736363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical