Healthcare Provider Details

I. General information

NPI: 1124901491
Provider Name (Legal Business Name): LINH NGOC HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 NORMANDY BLVD
JACKSONVILLE FL
32205-6201
US

IV. Provider business mailing address

PO BOX 878
DAVENPORT FL
33836-0878
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-1901
  • Fax: 904-388-3169
Mailing address:
  • Phone: 689-223-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number116188
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: