Healthcare Provider Details

I. General information

NPI: 1649378761
Provider Name (Legal Business Name): PHAN NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW HEALTH PKWY STE 303
NAPLES FL
34109-0473
US

IV. Provider business mailing address

PO BOX 81798
CLEVELAND OH
44181-0798
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-0990
  • Fax:
Mailing address:
  • Phone: 613-002-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5101013356
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberOS12836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: