Healthcare Provider Details

I. General information

NPI: 1265240600
Provider Name (Legal Business Name): TYLER NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W PLANO PKWY STE 100
PLANO TX
75093-5617
US

IV. Provider business mailing address

4031 W PLANO PKWY STE 100
PLANO TX
75093-5617
US

V. Phone/Fax

Practice location:
  • Phone: 972-492-1334
  • Fax:
Mailing address:
  • Phone: 972-492-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: