Healthcare Provider Details

I. General information

NPI: 1063678498
Provider Name (Legal Business Name): TUAN THANH NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 OLD GROVES RD 201
NAPLES FL
34109
US

IV. Provider business mailing address

4906 GRASSLEAF DR
PALM BEACH GARDENS FL
33418-6725
US

V. Phone/Fax

Practice location:
  • Phone: 239-300-9721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number321225
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME105279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: