Provider Demographics
NPI:1437776903
Name:TRUJILLO, TERESA AMELIA (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:AMELIA
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MERIDIAN AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 MERIDIAN AVE APT 14
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6542
Practice Address - Country:US
Practice Address - Phone:305-619-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172950163W00000X
AK160914163W00000X
CA95178018163W00000X
CT160798163W00000X
DCRN1049599163W00000X
HI94500163W00000X
IL041466307163W00000X
IN28244836A163W00000X
IN99086756A163W00000X
MARN2324277163W00000X
MN2467617163W00000X
MI4704345352163W00000X
NV815617163W00000X
NJ26NR20163600163W00000X
FLRN9444346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse