Healthcare Provider Details

I. General information

NPI: 1457611089
Provider Name (Legal Business Name): CATHLYN LUU NGUYEN CARIGNAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHLYN LUU NGUYEN DPT

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N JEFFERSON ST
JACKSONVILLE FL
32209-6810
US

IV. Provider business mailing address

910 N JEFFERSON ST
JACKSONVILLE FL
32209-6810
US

V. Phone/Fax

Practice location:
  • Phone: 904-360-7022
  • Fax:
Mailing address:
  • Phone: 904-360-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3498
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT31359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: