Healthcare Provider Details

I. General information

NPI: 1154510956
Provider Name (Legal Business Name): QUYEN D NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 LUCERNE TER
ORLANDO FL
32806-1017
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 407-316-8550
  • Fax: 407-316-8311
Mailing address:
  • Phone: 813-286-0333
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME106749
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME106749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: