Individual
TRISTA RAE PENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 988-5187
Mailing address
41 MELBA ST, MILFORD, CT 06460-7438
(860) 334-7901
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4561
CT
363AS0400X
Surgical Physician Assistant
4561
CT
Other
Enumeration date
06/17/2019
Last updated
09/18/2022
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