MEDICARE: PHUOC NGUYEN MS, RDN, LDN

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	133V00000X	Registered Dietitian	ND14900	FL

General Provider Information

NPI Number	:	1700721172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUOC NGUYEN MS, RDN, LDN

Provider Business Mailing Address
First Line	:	1050 95TH ST APT 1
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2113
Country	:	US
Telephone Number	:	407-962-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	3766 BENSON PARK BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7337
Country	:	US
Telephone Number	:	407-962-5253
Fax Number	:

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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