Provider Demographics
NPI:1619443363
Name:TRUJILLO CUE, MARCOS (APRN)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:TRUJILLO CUE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WORTH RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3213
Mailing Address - Country:US
Mailing Address - Phone:561-966-7717
Mailing Address - Fax:888-316-2198
Practice Address - Street 1:140 JFK DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6608
Practice Address - Country:US
Practice Address - Phone:561-968-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9458139363LA2200X
FLAPRN9548139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health