Healthcare Provider Details

I. General information

NPI: 1104654862
Provider Name (Legal Business Name): THUY LINH NGOC PHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S ORANGE AVE STE 103
ORLANDO FL
32806-2946
US

IV. Provider business mailing address

1717 S ORANGE AVE STE 103
ORLANDO FL
32806-2946
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-843-1753
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-843-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11036048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: