Provider Demographics
NPI:1770460149
Name:NGUYEN, TY (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13709 LUBECK DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2063
Mailing Address - Country:US
Mailing Address - Phone:214-642-3982
Mailing Address - Fax:
Practice Address - Street 1:7200 WYOMING SPRINGS DR STE 500
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4307
Practice Address - Country:US
Practice Address - Phone:512-879-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1209737363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care