Provider Demographics
NPI:1215750260
Name:NGUYEN, DUYEN THI BICH
Entity type:Individual
Prefix:
First Name:DUYEN
Middle Name:THI BICH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11827 FOUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6392
Mailing Address - Country:US
Mailing Address - Phone:571-325-8245
Mailing Address - Fax:
Practice Address - Street 1:11827 FOUNDERS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6392
Practice Address - Country:US
Practice Address - Phone:571-325-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG182671302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization