Healthcare Provider Details

I. General information

NPI: 1386531481
Provider Name (Legal Business Name): THU NGOC HUA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11429 TANGLE BRANCH LN
GIBSONTON FL
33534-5344
US

IV. Provider business mailing address

11429 TANGLE BRANCH LN
GIBSONTON FL
33534-5344
US

V. Phone/Fax

Practice location:
  • Phone: 813-545-5650
  • Fax:
Mailing address:
  • Phone: 813-545-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: