Provider Demographics
NPI:1457467938
Name:TRUJILLO, ANGELA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 EASY ST
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-2336
Mailing Address - Country:US
Mailing Address - Phone:254-749-4298
Mailing Address - Fax:254-803-2623
Practice Address - Street 1:415 EASY ST
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-2336
Practice Address - Country:US
Practice Address - Phone:254-749-4298
Practice Address - Fax:254-803-2623
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1460Medicare ID - Type UnspecifiedNURSE PRACTIONER
TXQ11983Medicare UPIN