Trinidad Delacruz Agtarap, GNP-BC
Individual provider Active NPI Gerontology Nurse Practitioner · Woodside, NY
NPI 1295962041 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1295962041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 340262 (NY)
- Practice address
- 4011 59TH St
Woodside, NY 11377-4837 - Phone
- (347) 589-3063
- Fax
- (347) 727-4305
- NPI assigned
- Jun 19, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 340262 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eta Medical Management Inc | Past |
Accepting new patients | |
| Rapid Access Medical Diagnostics PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Wound Care Registered Nurse | 163WW0000X | 327245 | NY | |
| Gerontology Nurse Practitioner | 363LG0600X | 340262 | NY | Yes |
Addresses
Primary practice location
4011 59TH St
Woodside, NY 11377-4837
Mailing address
4011 59TH St
Woodside, NY 11377-4837
Phone (347) 589-3063
Other practice location 1
5718 Woodside Ave Fl 2
Woodside, NY 11377-3444
Phone (718) 205-0030
Other practice location 2
7116 34th Ave Apt 2A
Jackson Heights, NY 11372-1016
Phone (347) 418-1698
Other providers in Woodside, NY
- Jaritza Adames
- Advanced Health Pro, Inc.
- Advanced Medical Healthcare, P.C.
- Natasha Agard
- Jeremiah Agtarap
- Gero Patrick Rojas Aguilar
- Laura Aguilera
- Erie T Agustin
- Frishta Ahmadi
- Aftab Ahmed
All providers in Woodside, NY · Gerontology Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.