Healthcare Provider Details

I. General information

NPI: 1417534785
Provider Name (Legal Business Name): QUAN NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 SUN N LAKE BLVD
SEBRING FL
33872-2166
US

IV. Provider business mailing address

2738 ROOSEVELT BLVD APT 514
CLEARWATER FL
33760-2531
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3763
  • Fax: 863-402-3765
Mailing address:
  • Phone: 213-446-2519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME169175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: