Healthcare Provider Details

I. General information

NPI: 1124717525
Provider Name (Legal Business Name): THU TANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 S SEACREST BLVD STE 102
BOYNTON BEACH FL
33435-6788
US

IV. Provider business mailing address

4402 COHUNE PALM CT
GREENACRES FL
33463-9329
US

V. Phone/Fax

Practice location:
  • Phone: 561-735-7766
  • Fax:
Mailing address:
  • Phone: 561-715-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9407906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: