Provider Demographics
NPI:1891580023
Name:NGUYEN, TRUC (NP)
Entity type:Individual
Prefix:
First Name:TRUC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RUSSELL PARK APT 305
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4527
Mailing Address - Country:US
Mailing Address - Phone:267-629-0372
Mailing Address - Fax:
Practice Address - Street 1:5 RUSSELL PARK APT 305
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4527
Practice Address - Country:US
Practice Address - Phone:267-629-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG10240049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner