Healthcare Provider Details

I. General information

NPI: 1033517388
Provider Name (Legal Business Name): YEN KIM THUY NGUYEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date: 07/23/2015
Reactivation Date: 08/27/2026

III. Provider practice location address

PSC 454 BOX 1098
APO AE
09250-0011
US

IV. Provider business mailing address

5134 OLD MAJETTE TOWER RD
PANAMA CITY FL
32404-3424
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3706
  • Fax:
Mailing address:
  • Phone: 850-774-2251
  • Fax: 850-522-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9246539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: