Provider Demographics
NPI:1609883651
Name:TRUJILLO, JENNIFER TAFOYA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TAFOYA
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3605
Mailing Address - Country:US
Mailing Address - Phone:505-317-7773
Mailing Address - Fax:855-844-8611
Practice Address - Street 1:101 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3605
Practice Address - Country:US
Practice Address - Phone:505-317-7773
Practice Address - Fax:855-844-8611
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2004-0023207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine