Provider Demographics
NPI:1558071324
Name:TRUJILLO, MIGUEL (FNP)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:TRUJILLO PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 NW 183RD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4579
Mailing Address - Country:US
Mailing Address - Phone:786-320-5229
Mailing Address - Fax:786-320-5279
Practice Address - Street 1:111 NW 183RD ST STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4579
Practice Address - Country:US
Practice Address - Phone:786-320-5229
Practice Address - Fax:786-320-5279
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11220945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily