Provider Demographics
NPI:1447241666
Name:NGUYEN, THANH THI BAC (FNP)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THI BAC
Last Name:NGUYEN
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 1:1064 STATE ROUTE 28 UNIT F
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4940
Mailing Address - Country:US
Mailing Address - Phone:513-981-4050
Mailing Address - Fax:513-322-4859
Practice Address - Street 1:1064 STATE ROUTE 28 UNIT F
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4940
Practice Address - Country:US
Practice Address - Phone:513-981-4050
Practice Address - Fax:513-322-4859
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018231363LF0000X
OR090000179N1363LF0000X
OHAPRN.CNP.0031988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00252360OtherRR MEDICARE
OR075569Medicaid
ORR132354Medicare PIN
ORR170821Medicare PIN
OR075569Medicaid
ORR144972Medicare PIN
ORR144973Medicare PIN
ORR130125Medicare PIN
ORR131710Medicare PIN
ORR153406Medicare PIN
ORR118959Medicare PIN
ORP00252360OtherRR MEDICARE
ORR145272Medicare PIN
ORR153407Medicare PIN
ORR144875Medicare PIN