Provider Demographics
NPI:1083349047
Name:TRU-HORMONES
Entity Type:Organization
Organization Name:TRU-HORMONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-329-3868
Mailing Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5424
Mailing Address - Country:US
Mailing Address - Phone:904-329-3868
Mailing Address - Fax:
Practice Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5424
Practice Address - Country:US
Practice Address - Phone:904-329-3868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty