Healthcare Provider Details

I. General information

NPI: 1295265593
Provider Name (Legal Business Name): ELIZABETH TIEN NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 UNIVERSITY DR E STE 100
BRYAN TX
77802-3499
US

IV. Provider business mailing address

8441 STATE HWY 47 STE 3115
BRYAN TX
77807
US

V. Phone/Fax

Practice location:
  • Phone: 799-776-0169
  • Fax: 799-776-1342
Mailing address:
  • Phone: 979-436-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberT9197
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME144828
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT9197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: