Provider Demographics
NPI:1790528073
Name:NGUYEN, MINH THI (PA)
Entity type:Individual
Prefix:
First Name:MINH THI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 CADENCE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-2727
Mailing Address - Country:US
Mailing Address - Phone:407-722-0149
Mailing Address - Fax:
Practice Address - Street 1:133 BENMORE DR STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4111
Practice Address - Country:US
Practice Address - Phone:407-644-4883
Practice Address - Fax:407-644-5445
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123463600Medicaid
FLTI557OtherMEDICARE HFPS
FLTI559OtherMEDICARE HFMG