Provider Demographics
NPI:1689149460
Name:NGUYEN, JOSEPHINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 GREENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1260
Mailing Address - Country:US
Mailing Address - Phone:858-357-4831
Mailing Address - Fax:
Practice Address - Street 1:1625 GREENSIDE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1260
Practice Address - Country:US
Practice Address - Phone:858-357-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily