Healthcare Provider Details

I. General information

NPI: 1306560172
Provider Name (Legal Business Name): THOMAS MINH NGUYEN CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

847 ROCKY MOUNTAIN CT
VALRICO FL
33594-9313
US

V. Phone/Fax

Practice location:
  • Phone: 813-916-1313
  • Fax:
Mailing address:
  • Phone: 727-238-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: