Healthcare Provider Details

I. General information

NPI: 1851365357
Provider Name (Legal Business Name): TAI QUYEN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W 8TH ST UFJP NEUROSURGERY
JACKSONVILLE FL
32209-6533
US

IV. Provider business mailing address

PO BOX 44008 UFJP NEUROSURGERY
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-9053
  • Fax: 904-244-3425
Mailing address:
  • Phone: 904-244-9053
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME35897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: