Provider Demographics
NPI:1225837453
Name:NGUYEN, KIMNGAN THI (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMNGAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1810
Mailing Address - Country:US
Mailing Address - Phone:407-222-6701
Mailing Address - Fax:
Practice Address - Street 1:7806 LAKE UNDERHILL RD STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8232
Practice Address - Country:US
Practice Address - Phone:407-483-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner