Healthcare Provider Details

I. General information

NPI: 1104759513
Provider Name (Legal Business Name): THI HONG VAN NGUYEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5000
  • Fax:
Mailing address:
  • Phone: 386-917-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: