Healthcare Provider Details

I. General information

NPI: 1528622719
Provider Name (Legal Business Name): QUANG DUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 WATERMAN WAY
TAVARES FL
32778-5252
US

IV. Provider business mailing address

PO BOX 935921
ATLANTA GA
31193-5921
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3251
  • Fax: 352-253-3644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number11000466
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: