Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jennifer Detrisac, MD

Individual provider Pediatrics Physician · NPI 1891132916

Jennifer Detrisac, MD is a Pediatrics Physician in Providence, Rhode Island. Practices as a sole proprietor. Licensed in Rhode Island.

Licensed in
RI
In the registry since
2013
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

593 Eddy St
Providence, RI 02903-4923
Phone: (401) 444-4471
Fax: (401) 444-7574
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence LP02788 (RI)

Record details

NPI number1891132916
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedMay 30, 2013
Last updated in NPPESFebruary 22, 2016
Mailing address593 Eddy St, Providence, RI 02903-4923

Other providers in Providence