Provider Demographics
NPI:1205452489
Name:TRYBULA, ANETA (RN, BSN, MSN, AGACNP)
Entity type:Individual
Prefix:
First Name:ANETA
Middle Name:
Last Name:TRYBULA
Suffix:
Gender:F
Credentials:RN, BSN, MSN, AGACNP
Other - Prefix:
Other - First Name:ANETA
Other - Middle Name:
Other - Last Name:MUCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10604 W 154TH PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6025
Mailing Address - Country:US
Mailing Address - Phone:708-515-2222
Mailing Address - Fax:
Practice Address - Street 1:10604 W 154TH PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6025
Practice Address - Country:US
Practice Address - Phone:708-515-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021360363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care