=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356803589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NHUMAI THI NGUYEN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2019
-----------------------------------------------------
Last Update Date | 04/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 E RIVERSIDE DR STE G3
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78741-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-472-4357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18212 CRIMSON APPLE WAY
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-685-4177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP140571
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP140571
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------