Individual provider Active NPI

Trevor Allen Kolski, PA-C

  • Surgical Physician Assistant
  • Fort Lauderdale, FL
National Provider Identifier
1417321894
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9109130 Issued in FL
Practice address
1995 E Oakland Park Blvd Ste 310
Fort Lauderdale, FL 33306-1138
Phone
(954) 791-6146
NPI assigned
Nov 22, 2015
Last updated
Jul 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9109130 FL
Surgical Physician Assistant 363AS0400X PA9109130 FL Primary

Addresses

Primary practice location

1995 E Oakland Park Blvd Ste 310
Fort Lauderdale, FL 33306-1138

Mailing address

PO Box 936535
Atlanta, GA 31193-6535

Other practice location 1

3890 Tampa Rd Ste 202
Palm Harbor, FL 34684-3677
Phone (727) 787-5577

Other practice location 2

13020 N Telecom Pkwy
Temple Terrace, FL 33637-0925
Phone (813) 978-9700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9248GAMDGeneral Practice Dentistry
PA9109130FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Resurgens, LLC PastSince Mar 1, 2022 Accepting new patients
Northside Surgical Professional Services LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tkolski2931050@direct.trinity-health.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1417321894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936535",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 E OAKLAND PARK BLVD STE 310",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061138",
            "telephone_number": "954-791-6146"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3890 Tampa Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Palm Harbor",
            "state": "FL",
            "postal_code": "346843677",
            "country_code": "US",
            "telephone_number": "727-787-5577",
            "fax_number": "727-781-7757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13020 N Telecom Pkwy",
            "address_purpose": "LOCATION",
            "city": "Temple Terrace",
            "state": "FL",
            "postal_code": "336370925",
            "country_code": "US",
            "telephone_number": "813-978-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLSKI",
        "first_name": "TREVOR",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-22",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109130",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9109130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.