Provider Demographics
NPI:1780344044
Name:SU, JAN ANTON TRUENO (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JAN ANTON
Middle Name:TRUENO
Last Name:SU
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HENDERSON CT
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2122
Mailing Address - Country:US
Mailing Address - Phone:862-228-4324
Mailing Address - Fax:
Practice Address - Street 1:8 HENDERSON CT
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2122
Practice Address - Country:US
Practice Address - Phone:862-228-4324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01248400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily