MEDICARE: JODIE NGUYEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA20056	TX

General Provider Information

NPI Number	:	1538977970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE NGUYEN PA-C

Provider Business Mailing Address
First Line	:	800 8TH AVE STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2602
Country	:	US
Telephone Number	:	682-224-3748
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 8TH AVE STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2602
Country	:	US
Telephone Number	:	682-224-3748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	04/06/2026

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Directions to “ JODIE NGUYEN PA-C” Practice Location

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