Provider Demographics
NPI:1295962041
Name:AGTARAP, TRINIDAD DELACRUZ (GNP-BC)
Entity type:Individual
Prefix:MISS
First Name:TRINIDAD
Middle Name:DELACRUZ
Last Name:AGTARAP
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 59TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4837
Mailing Address - Country:US
Mailing Address - Phone:347-589-3063
Mailing Address - Fax:347-727-4305
Practice Address - Street 1:4011 59TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4837
Practice Address - Country:US
Practice Address - Phone:347-589-3063
Practice Address - Fax:347-727-4305
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327245163WW0000X
NY340262363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WW0000XNursing Service ProvidersRegistered NurseWound Care