Provider Demographics
NPI:1780202945
Name:NGUYEN, VIVI (ARNP)
Entity Type:Individual
Prefix:
First Name:VIVI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MISTFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4863
Mailing Address - Country:US
Mailing Address - Phone:407-412-8265
Mailing Address - Fax:
Practice Address - Street 1:1700 SAND LAKE RD STE D112
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-9149
Practice Address - Country:US
Practice Address - Phone:407-440-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner