Provider Demographics
NPI:1437756566
Name:TRULEY, DIANE CAMILLE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CAMILLE
Last Name:TRULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4254
Mailing Address - Country:US
Mailing Address - Phone:407-886-1171
Mailing Address - Fax:407-886-8386
Practice Address - Street 1:125 S PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4254
Practice Address - Country:US
Practice Address - Phone:407-886-1171
Practice Address - Fax:407-886-8386
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10200063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF10200063Medicaid