Healthcare Provider Details

I. General information

NPI: 1902792146
Provider Name (Legal Business Name): JULIA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 KINGSLEY AVE STE 103
ORANGE PARK FL
32073-4503
US

IV. Provider business mailing address

7507 PARK VILLAGE DR APT 1217
JACKSONVILLE FL
32256-0299
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-8070
  • Fax:
Mailing address:
  • Phone: 901-608-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11044226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40543
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: