Provider Demographics
NPI:1801765631
Name:NGUYEN, HA KIM
Entity type:Individual
Prefix:
First Name:HA
Middle Name:KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 KIESSEL RD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2910
Mailing Address - Country:US
Mailing Address - Phone:352-914-3451
Mailing Address - Fax:352-415-3952
Practice Address - Street 1:3614 KIESSEL RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2910
Practice Address - Country:US
Practice Address - Phone:352-914-3451
Practice Address - Fax:352-415-3952
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily