Healthcare Provider Details

I. General information

NPI: 1124211164
Provider Name (Legal Business Name): ACCESS PRONTO FAMILY MEDICINE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 17TH ST
SAINT CLOUD FL
34769-6018
US

IV. Provider business mailing address

2918 17TH ST
SAINT CLOUD FL
34769-6018
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-8887
  • Fax: 407-892-8878
Mailing address:
  • Phone: 407-892-8887
  • Fax: 407-892-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME95889
License Number StateFL

VIII. Authorized Official

Name: DR. HANSON VAN NGUYEN
Title or Position: OWNER
Credential: M.D.
Phone: 850-435-8300