=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811488273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIZA TRIOLO PSYD, APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2018
-----------------------------------------------------
Last Update Date | 09/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4274 HARBOR BEACH BLVD
-----------------------------------------------------
City | BRIGANTINE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08203-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-340-0492
-----------------------------------------------------
Fax | 732-734-1962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 14TH ST N APT B
-----------------------------------------------------
City | BRIGANTINE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08203-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-669-8305
-----------------------------------------------------
Fax | 732-734-1962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00829700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------