Provider Demographics
NPI:1386118412
Name:TRINIDAD D AGTARAP NURSE PRACTITIONER IN GERONTOLOGY PLLC
Entity type:Organization
Organization Name:TRINIDAD D AGTARAP NURSE PRACTITIONER IN GERONTOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINIDAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:AGTARAP
Authorized Official - Suffix:
Authorized Official - Credentials:GNP-BC
Authorized Official - Phone:347-507-1197
Mailing Address - Street 1:7116 34TH AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1016
Mailing Address - Country:US
Mailing Address - Phone:347-507-1197
Mailing Address - Fax:
Practice Address - Street 1:7116 34TH AVE APT 2B
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1016
Practice Address - Country:US
Practice Address - Phone:347-507-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service