Healthcare Provider Details

I. General information

NPI: 1043780521
Provider Name (Legal Business Name): JIMMY DUY NGUYEN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 CORTEZ RD W
BRADENTON FL
34210-2817
US

IV. Provider business mailing address

5534 CORTEZ RD W
BRADENTON FL
34210-2817
US

V. Phone/Fax

Practice location:
  • Phone: 941-757-2100
  • Fax: 941-757-2101
Mailing address:
  • Phone: 941-757-2100
  • Fax: 941-757-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9356179
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9356179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: