Healthcare Provider Details

I. General information

NPI: 1669794905
Provider Name (Legal Business Name): VINH LOC NGUYEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SW 18TH CT STE 200
OCALA FL
34471
US

IV. Provider business mailing address

5365 W ATLANTIC AVE STE 504
DELRAY BEACH FL
33484-8194
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-7011
  • Fax: 866-592-7773
Mailing address:
  • Phone: 561-241-9300
  • Fax: 561-241-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: