Healthcare Provider Details

I. General information

NPI: 1932858552
Provider Name (Legal Business Name): NICOLE VUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W OAK ST STE 201
KISSIMMEE FL
34741-4998
US

IV. Provider business mailing address

720 W OAK ST STE 201
KISSIMMEE FL
34741-4998
US

V. Phone/Fax

Practice location:
  • Phone: 321-697-1733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME174821
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME174821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: