Provider Demographics
NPI:1902435506
Name:TRUJILLO, BRANDI LANAE (AGACNP, FNP)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:LANAE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:AGACNP, FNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LANAE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3107 E SPAULDING AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-5219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3676 PARKER BLVD STE 260
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2282
Practice Address - Country:US
Practice Address - Phone:719-553-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995320-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily