Provider Demographics
NPI:1629097936
Name:NGUYEN, VAN (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 SADDLEWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4125
Mailing Address - Country:US
Mailing Address - Phone:407-737-4052
Mailing Address - Fax:407-836-2672
Practice Address - Street 1:832 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1809
Practice Address - Country:US
Practice Address - Phone:407-836-2645
Practice Address - Fax:407-836-2672
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036511207QA0505X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0394807-00Medicaid
FL15582XMedicare PIN
FL15582YMedicare ID - Type Unspecified
FL0394807-00Medicaid