Healthcare Provider Details

I. General information

NPI: 1619625746
Provider Name (Legal Business Name): VANNIE DARACAN NGUYEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANNIE D VICTORINO NP

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 BLACKMON RD
COLUMBUS GA
31909-4478
US

IV. Provider business mailing address

14318 W BURTON ST
WICHITA KS
67235-9160
US

V. Phone/Fax

Practice location:
  • Phone: 706-383-0910
  • Fax:
Mailing address:
  • Phone: 620-314-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP004903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: