Provider Demographics
NPI:1114521333
Name:NGUYEN, TRISTA TRINH
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:TRINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 LAUREL BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5205
Mailing Address - Country:US
Mailing Address - Phone:321-310-3716
Mailing Address - Fax:
Practice Address - Street 1:2539 LAUREL BLOSSOM CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5205
Practice Address - Country:US
Practice Address - Phone:321-310-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21282183500000X
FLPS60270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist