Provider Demographics
NPI:1538445804
Name:TRYON, LISA (PA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TRYON
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST.
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-8879
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:56 FRANKLIN ST.
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6000
Practice Address - Fax:203-709-3700
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2023-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT2631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant