MEDICARE: TAI QUYEN NGUYEN MD

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	207T00000X	Neurological Surgery Physician	ME35897	FL

General Provider Information

NPI Number	:	1851365357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAI QUYEN NGUYEN MD

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP NEUROSURGERY
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-9053
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	580 W 8TH ST
Second Line	:	UFJP NEUROSURGERY
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6533
Country	:	US
Telephone Number	:	904-244-9053
Fax Number	:	904-244-3425

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/30/2007

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