Provider Demographics
NPI:1720388184
Name:NGUYEN, JULIE NGOC (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOBILE INFIRMARY CIR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3513
Mailing Address - Country:US
Mailing Address - Phone:251-435-2646
Mailing Address - Fax:251-435-6478
Practice Address - Street 1:5600 GIRBY RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3320
Practice Address - Country:US
Practice Address - Phone:251-660-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105681363A00000X
AL732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant