Provider Demographics
NPI:1053716050
Name:TROXELL, ANNSLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNSLEY
Middle Name:MARIE
Last Name:TROXELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING COORDINATOR
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-524-8171
Mailing Address - Fax:844-296-2307
Practice Address - Street 1:BEAUFORT MEMORIAL SURGICAL SPECIALISTS
Practice Address - Street 2:1680 RIBAUT RD
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-524-2307
Practice Address - Fax:844-296-2307
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2522PAMedicaid
SC1942261185Medicaid
SC5918244OtherAETNA
SCG031916372OtherMEDICARE
SC1942261185Medicaid