Healthcare Provider Details

I. General information

NPI: 1992914659
Provider Name (Legal Business Name): LAURIE ANN TRUOG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 SAINT AUGUSTINE RD
JACKSONVILLE FL
32207-8030
US

IV. Provider business mailing address

13853 HILLANDALE DR
JACKSONVILLE FL
32225-1901
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-4700
  • Fax:
Mailing address:
  • Phone: 904-333-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME0103475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: