Healthcare Provider Details

I. General information

NPI: 1336843473
Provider Name (Legal Business Name): CAROLYN ELIZABETH TRUJILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11269 SW 58TH CT
COOPER CITY FL
33330-4520
US

IV. Provider business mailing address

11269 SW 58TH CT
COOPER CITY FL
33330-4520
US

V. Phone/Fax

Practice location:
  • Phone: 786-774-9482
  • Fax:
Mailing address:
  • Phone: 786-774-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9461293
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11028106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: