Provider Demographics
NPI:1124309489
Name:NGUYEN, THOA THI (APRN)
Entity type:Individual
Prefix:
First Name:THOA
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOLLEY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3062
Mailing Address - Country:US
Mailing Address - Phone:860-769-9866
Mailing Address - Fax:860-769-7300
Practice Address - Street 1:35 JOLLEY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3062
Practice Address - Country:US
Practice Address - Phone:860-769-9866
Practice Address - Fax:860-769-7300
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004758363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004047585Medicaid