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General NPI Number Information
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NPI Number | 1700390291
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Entity Type | Individual
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Provider Name | MY NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 13330 USF LAUREL DR
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City | TAMPA
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State | FL
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Zip | 33612-6601
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Country | US
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Telephone | 813-974-3725
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Fax | 813-974-9476
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Provider Business Mailing Address
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Address Line | PO BOX 917770
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 813-821-8038
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Fax | 813-974-0483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118531
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License Number State | FL
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