Provider Demographics
NPI:1164029906
Name:NGUYEN, PHUOC (CRNA)
Entity Type:Individual
Prefix:
First Name:PHUOC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 E CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3971
Mailing Address - Country:US
Mailing Address - Phone:267-644-6825
Mailing Address - Fax:
Practice Address - Street 1:JEFFERSON TORRESDALE HOSPITAL
Practice Address - Street 2:10800 KNIGHTS RD,
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131807367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered