Healthcare Provider Details

I. General information

NPI: 1639577208
Provider Name (Legal Business Name): NINA MARIE TROJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 BRUCE B DOWNS BLVD
TAMPA FL
33612-3803
US

IV. Provider business mailing address

12028 TUSCANY BAY DR APT 301
TAMPA FL
33626-1382
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-0602
  • Fax: 813-558-1343
Mailing address:
  • Phone: 727-992-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: