Provider Demographics
NPI:1891134243
Name:NGUYEN, MAIKA TAN (DO)
Entity Type:Individual
Prefix:MISS
First Name:MAIKA
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4945
Mailing Address - Country:US
Mailing Address - Phone:727-841-8772
Mailing Address - Fax:
Practice Address - Street 1:4759 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-841-8772
Practice Address - Fax:727-841-5897
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6301207Q00000X
FLOS17168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine