MEDICARE: MR. THO TRUONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9118816	FL

General Provider Information

NPI Number	:	1881443034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THO TRUONG

Provider Business Mailing Address
First Line	:	655 W 8TH ST FL CENTER2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-8203
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-8203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	12/01/2025

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Directions to “ MR. THO TRUONG ” Practice Location

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