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General NPI Number Information
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NPI Number | 1740704790
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Entity Type | Individual
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Provider Name | TAN NGUYEN FNP
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Gender | Male
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 631 PROFESSIONAL DRIVE SUITE 170
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 678-312-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 631 PROFESSIONAL DR STE 170
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3392
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Country | US
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Telephone | 678-312-2663
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN223312
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License Number State | GA
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