Provider Demographics
NPI:1295497956
Name:NGUYEN, CHAU NGOC (APRN)
Entity type:Individual
Prefix:MR
First Name:CHAU
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:392 RINEHART RD STE 3040
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2548
Mailing Address - Country:US
Mailing Address - Phone:863-513-3458
Mailing Address - Fax:
Practice Address - Street 1:392 RINEHART RD
Practice Address - Street 2:STE 3040, MP 177
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2548
Practice Address - Country:US
Practice Address - Phone:321-841-4194
Practice Address - Fax:321-843-6432
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11013309363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner