MEDICARE: HUONG 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	363LA2100X	Acute Care Nurse Practitioner	1078883	TX

General Provider Information

NPI Number	:	1952039596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUONG NGUYEN

Provider Business Mailing Address
First Line	:	1325 PENNSYLVANIA AVE STE 370
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2110
Country	:	US
Telephone Number	:	817-778-0777
Fax Number	:	817-479-9082

Provider Business Practice Location Address
First Line	:	1325 PENNSYLVANIA AVE STE 370
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2110
Country	:	US
Telephone Number	:	817-778-0777
Fax Number	:	817-479-9082

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ HUONG NGUYEN ” Practice Location

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