Provider Demographics
NPI:1386697829
Name:TRUNNELL, PAULA JOSETTE (ARNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JOSETTE
Last Name:TRUNNELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 FOREST HILL BLVD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5940
Mailing Address - Country:US
Mailing Address - Phone:561-968-7600
Mailing Address - Fax:561-968-0443
Practice Address - Street 1:3098 FOREST HILL BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5940
Practice Address - Country:US
Practice Address - Phone:561-968-7600
Practice Address - Fax:561-968-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003872363L00000X
TX852920363L00000X
TXAP125533363L00000X
FL11001904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617259Medicaid
S55854Medicare UPIN
8853463Medicare ID - Type Unspecified
WA9617259Medicaid