Healthcare Provider Details

I. General information

NPI: 1134061989
Provider Name (Legal Business Name): ANN THIEN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CHANNELSIDE DR
TAMPA FL
33602-5618
US

IV. Provider business mailing address

560 CHANNELSIDE DR
TAMPA FL
33602-5618
US

V. Phone/Fax

Practice location:
  • Phone: 813-369-9459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: