Healthcare Provider Details

I. General information

NPI: 1407687015
Provider Name (Legal Business Name): JADE NGUYEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARQUETTE AVE NW STE B606
ALBUQUERQUE NM
87102-2117
US

IV. Provider business mailing address

3503 PAESANOS PKWY STE 101
SAN ANTONIO TX
78231-1225
US

V. Phone/Fax

Practice location:
  • Phone: 505-602-9355
  • Fax:
Mailing address:
  • Phone: 210-492-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: