Provider Demographics
NPI:1790151074
Name:NGUYEN, TONY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
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 1:11472 CORIENDER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2417
Mailing Address - Country:US
Mailing Address - Phone:714-414-6800
Mailing Address - Fax:
Practice Address - Street 1:11942 PARAMOUNT BLVD STE B
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2306
Practice Address - Country:US
Practice Address - Phone:562-923-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily