Healthcare Provider Details

I. General information

NPI: 1386663029
Provider Name (Legal Business Name): TIFFANI TRANG NGUYEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANI TRANG GWEN NP

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date: 08/22/2017
Reactivation Date: 04/12/2018

III. Provider practice location address

1401 W 1ST ST STE 101
SANTA ANA CA
92703-3757
US

IV. Provider business mailing address

16027 BROOKHURST ST #G158
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-9700
  • Fax:
Mailing address:
  • Phone: 949-910-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95007871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: