Provider Demographics
NPI:1497851604
Name:NGUYEN, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693
Mailing Address - Country:US
Mailing Address - Phone:352-463-7381
Mailing Address - Fax:352-463-7273
Practice Address - Street 1:308 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693
Practice Address - Country:US
Practice Address - Phone:352-463-7381
Practice Address - Fax:352-463-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-12-17
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-17
Provider Licenses
StateLicense IDTaxonomies
FLME43248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL233749OtherAV-MED HEALTH PLANS
FL05067200OtherVISTA
FL592920999001OtherTRI CARE
FL05067200OtherVISTA
FL21007Medicare PIN
FLD53408Medicare UPIN