Provider Demographics
NPI:1467495614
Name:TRUDEL, AMBER JANE (NP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JANE
Last Name:TRUDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-8525
Mailing Address - Country:US
Mailing Address - Phone:508-341-1942
Mailing Address - Fax:800-883-4272
Practice Address - Street 1:150 S PINE ISLAND RD STE 540
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2667
Practice Address - Country:US
Practice Address - Phone:508-341-1942
Practice Address - Fax:800-883-4272
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9415703363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI49540OtherBLUE SHIELD
M16425OtherBLUE SHIELD
MANP3468OtherBLUE SHIELD
MA9778446Medicaid
RI410937OtherBLUE CHIP
RI49540OtherBLUE SHIELD
M16425OtherBLUE SHIELD
NP3468Medicare ID - Type Unspecified