Provider Demographics
NPI:1184149924
Name:NGUYEN, TANVU VINCENT
Entity type:Individual
Prefix:
First Name:TANVU
Middle Name:VINCENT
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 SEMINOLE PRATT WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3474
Mailing Address - Country:US
Mailing Address - Phone:561-383-6183
Mailing Address - Fax:
Practice Address - Street 1:7050 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3474
Practice Address - Country:US
Practice Address - Phone:561-383-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI32737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI32737OtherFLORIDA STATE LICENSE