Provider Demographics
NPI:1386243830
Name:NGUYEN, KEVIN KHOA (NP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:KHOA
Last Name:NGUYEN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KHOA
Other - Middle Name:DANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4367 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4828
Mailing Address - Country:US
Mailing Address - Phone:386-758-6094
Mailing Address - Fax:386-758-6995
Practice Address - Street 1:4367 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4828
Practice Address - Country:US
Practice Address - Phone:386-758-6094
Practice Address - Fax:386-758-6995
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009845363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health