Healthcare Provider Details

I. General information

NPI: 1407237530
Provider Name (Legal Business Name): ANA GABRIELLE TRUJILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E 68TH ST
TULSA OK
74136-3307
US

IV. Provider business mailing address

5020 E 68TH ST
TULSA OK
74136-3307
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-3636
  • Fax: 918-494-8915
Mailing address:
  • Phone: 918-492-3636
  • Fax: 918-494-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0100501
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: