Provider Demographics
NPI:1871021436
Name:TRUJILLO, TINA SUE (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:SUE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5679
Mailing Address - Country:US
Mailing Address - Phone:620-272-2222
Mailing Address - Fax:620-275-3756
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-275-3035
Practice Address - Fax:620-275-3756
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-77873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner