Healthcare Provider Details

I. General information

NPI: 1104620921
Provider Name (Legal Business Name): MR. ALEX NGHIA LAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SEMINOLE BLVD STE C
LARGO FL
33770-3627
US

IV. Provider business mailing address

716 SEMINOLE BLVD STE C
LARGO FL
33770-3627
US

V. Phone/Fax

Practice location:
  • Phone: 727-238-3241
  • Fax: 727-238-8402
Mailing address:
  • Phone: 727-238-3241
  • Fax: 727-238-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11038621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: