Basic Information
| Provider Information | |||||||||
| NPI: | 1710386123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOON | ||||||||
| FirstName: | TRUDY | ||||||||
| MiddleName: | ALYCE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ADULT NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 E OSCEOLA PKWY | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347441611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074523700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 31861 GATEWAY CENTER BLVD S STE A | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980035616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416527215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 9201429 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | AP60708435 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | 201502243NP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.