Provider Demographics
NPI:1043968209
Name:DINH-BAILEY, PHUONG QUYEN THI (FNP)
Entity Type:Individual
Prefix:
First Name:PHUONG QUYEN
Middle Name:THI
Last Name:DINH-BAILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 SUMAC CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4977
Mailing Address - Country:US
Mailing Address - Phone:727-278-9893
Mailing Address - Fax:
Practice Address - Street 1:1818 SHORT BRANCH DR STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4425
Practice Address - Country:US
Practice Address - Phone:727-332-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9339067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily