MEDICARE: CHRISTOPHER NGUYEN

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	363LF0000X	Family Nurse Practitioner	AP129712	TX

General Provider Information

NPI Number	:	1720452071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER NGUYEN

Provider Business Mailing Address
First Line	:	609 HEMPHILL ST
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3149
Country	:	US
Telephone Number	:	817-923-8484
Fax Number	:	817-923-8494

Provider Business Practice Location Address
First Line	:	609 HEMPHILL ST
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3149
Country	:	US
Telephone Number	:	817-923-8484
Fax Number	:	817-923-8494

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

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	11/24/2015

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Directions to “ CHRISTOPHER NGUYEN ” Practice Location

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