Provider Demographics
NPI:1972998094
Name:NGUYEN, THANH THI PHUONG (FNP)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THI PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18225 BROOKHURST ST
Mailing Address - Street 2:STE 5
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6719
Mailing Address - Country:US
Mailing Address - Phone:714-418-9749
Mailing Address - Fax:714-418-1047
Practice Address - Street 1:16543 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2343
Practice Address - Country:US
Practice Address - Phone:714-418-9749
Practice Address - Fax:714-418-1047
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner