Provider Demographics
NPI:1386663029
Name:NGUYEN, TIFFANI TRANG (NP)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:TRANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:TRANG
Other - Last Name:GWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:16027 BROOKHURST ST #G158
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:949-910-7675
Mailing Address - Fax:
Practice Address - Street 1:1401 W 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3757
Practice Address - Country:US
Practice Address - Phone:714-542-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-12-24
Deactivation Date:2017-08-22
Deactivation Code:
Reactivation Date:2018-04-12
Provider Licenses
StateLicense IDTaxonomies
CANP95007871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21454Medicaid
CADC21454AMedicare ID - Type UnspecifiedMEDICARE
CADC21454Medicaid