Healthcare Provider Details

I. General information

NPI: 1265097539
Provider Name (Legal Business Name): GARRETT NGUYEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

PO BOX 20802
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-830-6971
  • Fax:
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: