{
"Npi": {
"NPI": "1720609084",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "NGUYEN",
"FirstName": "CONSTANCE",
"MiddleName": "T",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NGUYEN",
"OtherFirstName": "CONNIE",
"OtherMiddleName": "T",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "FNP-C",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "7318 HARPERS RIDGE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TYLER",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75703-7086",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-569-7062",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3508 FAR WEST BLVD STE 130",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AUSTIN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78731-3081",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-293-6822",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/28/2020",
"LastUpdateDate": "02/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "F10220127",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "873316",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}