MEDICARE: JUSTIN TRUNZO CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP019475	PA

General Provider Information

NPI Number	:	1417424276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TRUNZO CRNP

Provider Business Mailing Address
First Line	:	738 SCENIC DR
Second Line	:
City	:	HOUSTON
State	:	PA
Zip	:	15342-1238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 TECHNOLOGY DR
Second Line	:
City	:	COAL CENTER
State	:	PA
Zip	:	15423-1065
Country	:	US
Telephone Number	:	724-223-1067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/18/2021

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