Healthcare Provider Details

I. General information

NPI: 1992242697
Provider Name (Legal Business Name): LAN NGUYEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BELFORT RD
JACKSONVILLE FL
32216-1431
US

IV. Provider business mailing address

370 BARBADOS DR
PONTE VEDRA FL
32081-1510
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3700
  • Fax:
Mailing address:
  • Phone: 571-331-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11001963
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024174405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: