MEDICARE: NGOC THAO NGUYEN 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790590198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGOC THAO NGUYEN NGUYEN

Provider Business Mailing Address
First Line	:	5219 ABBEY PARK AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2744
Country	:	US
Telephone Number	:	469-922-6401
Fax Number	:

Provider Business Practice Location Address
First Line	:	5219 ABBEY PARK AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2744
Country	:	US
Telephone Number	:	469-922-6401
Fax Number	:

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

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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