Healthcare Provider Details

I. General information

NPI: 1245816164
Provider Name (Legal Business Name): MICHELLE THANH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST STE 5270
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

8823 AUDREY LN
TAMPA FL
33615-3701
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-1471
  • Fax: 352-265-5606
Mailing address:
  • Phone: 813-952-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA196286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: