Healthcare Provider Details

I. General information

NPI: 1619663069
Provider Name (Legal Business Name): NIXON VAN NGUYEN PA STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

V. Phone/Fax

Practice location:
  • Phone: 353-333-5000
  • Fax:
Mailing address:
  • Phone: 352-333-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberPA9120326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: