Healthcare Provider Details

I. General information

NPI: 1508591132
Provider Name (Legal Business Name): VINH DOQUANG MSN, APRN, AG-CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 11/28/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 VENDEMMIA BND
AUSTIN TX
78738-1166
US

IV. Provider business mailing address

575 VENDEMMIA BND
AUSTIN TX
78738-1166
US

V. Phone/Fax

Practice location:
  • Phone: 512-893-5986
  • Fax: 512-777-5974
Mailing address:
  • Phone: 512-893-5986
  • Fax: 512-777-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1002145
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1002145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: