Provider Demographics
NPI:1922212216
Name:TRULOVE, GERILYN KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:GERILYN
Middle Name:KAY
Last Name:TRULOVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GERILYN
Other - Middle Name:
Other - Last Name:TRULOVE-MELLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5968 E MINING CAMP ST
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-9572
Mailing Address - Country:US
Mailing Address - Phone:480-694-4014
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5646
Practice Address - Country:US
Practice Address - Phone:928-468-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5208363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13955576OtherCAQH