Provider Demographics
NPI:1376395426
Name:TRUJILLO, TANYA MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MARIE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370681
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937-0681
Mailing Address - Country:US
Mailing Address - Phone:915-328-9797
Mailing Address - Fax:
Practice Address - Street 1:1122 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5510
Practice Address - Country:US
Practice Address - Phone:915-328-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156599363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health