Provider Demographics
NPI:1710622840
Name:TRUJILLO, JACQUELYN KRISTEN (APRN-NP, RNFA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:KRISTEN
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:APRN-NP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6018
Mailing Address - Country:US
Mailing Address - Phone:904-446-3701
Mailing Address - Fax:904-446-3032
Practice Address - Street 1:375 SE NORTON LN STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8484
Practice Address - Country:US
Practice Address - Phone:503-472-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041838RN163WR0006X
OR10001033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant