Healthcare Provider Details

I. General information

NPI: 1447752852
Provider Name (Legal Business Name): ANDREW NGUYEN DAO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4759 SOUTH FWY
FORT WORTH TX
76115-3655
US

IV. Provider business mailing address

1909 SCHUMAC LN
BEDFORD TX
76022-6808
US

V. Phone/Fax

Practice location:
  • Phone: 817-923-7374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136837
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP136837
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAP136837
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: