Provider Demographics
NPI:1043716749
Name:ALSTON, TRUDY-ANN CAMELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:TRUDY-ANN
Middle Name:CAMELLE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 W CANTON AVE STE G100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3050
Mailing Address - Country:US
Mailing Address - Phone:407-901-4086
Mailing Address - Fax:
Practice Address - Street 1:1030 W CANTON AVE STE G100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3050
Practice Address - Country:US
Practice Address - Phone:407-901-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program