Doctor Name: | DR. TRACY A TRUCHELUT |
NPI Number: | 1558350090 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | ME47684 |
Business Practice Address: | 1925 Mizell Ave Suite 302 Winter Park, FL - 327924106 |
Business Phone Number: | 4076296646 |
Business Fax Number: | 4077405089 |
Mailing Address: | 1925 Mizell Ave, Suite 302 WINTER PARK |
State: | FL |
Postal Code: | 327924106 |
Phone Number: | 4076296646 |
Fax Number: | 4077405089 |
NPI Enumeration Date: | 10/18/2005 |
NPI Last Update Date: | 08/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME47684 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |