Provider Demographics
NPI:1205898236
Name:NGUYEN, VAN Q (MD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEASE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6604
Mailing Address - Country:US
Mailing Address - Phone:727-724-8611
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-724-8611
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68214207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022519800Medicaid
FL022519800Medicaid
FLE56675Medicare UPIN
FL26958XMedicare PIN