Provider Demographics
NPI:1083272462
Name:NGUYEN, NGAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:NGAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 W WALNUT ST STE 225
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7140
Mailing Address - Country:US
Mailing Address - Phone:972-272-7816
Mailing Address - Fax:
Practice Address - Street 1:3465 W WALNUT ST STE 225
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7140
Practice Address - Country:US
Practice Address - Phone:972-272-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily