MEDICARE: KIMBERLY THI 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	225X00000X	Occupational Therapist	OT24157	FL

General Provider Information

NPI Number	:	1750230322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY THI NGUYEN

Provider Business Mailing Address
First Line	:	221 PHOENETIA DR
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-7312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 PHOENETIA DR
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-7312
Country	:	US
Telephone Number	:	904-613-7795
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ KIMBERLY THI NGUYEN ” Practice Location

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