Provider Demographics
NPI:1669794905
Name:NGUYEN, VINH LOC (PA)
Entity type:Individual
Prefix:
First Name:VINH
Middle Name:LOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5365 W ATLANTIC AVE
Mailing Address - Street 2:STE 504
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8194
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:1910 SW 18TH CT STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-629-7011
Practice Address - Fax:866-592-7773
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2022-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCY173YOtherMEDICARE