Provider Demographics
NPI:1063721413
Name:TRUONG, CHI TUONG (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CHI
Middle Name:TUONG
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13527 DANIELS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4365
Mailing Address - Country:US
Mailing Address - Phone:216-849-0549
Mailing Address - Fax:
Practice Address - Street 1:1287 N SEMORAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3530
Practice Address - Country:US
Practice Address - Phone:407-273-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant