Provider Demographics
NPI:1962518811
Name:NGUYEN, ANN THUY (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0936
Mailing Address - Country:US
Mailing Address - Phone:850-837-0576
Mailing Address - Fax:850-837-1051
Practice Address - Street 1:4012 COMMONS DR W
Practice Address - Street 2:SUITE 100
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8422
Practice Address - Country:US
Practice Address - Phone:850-837-0576
Practice Address - Fax:850-837-1051
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77139207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49256OtherBCBS
K2115Medicare ID - Type Unspecified
H03497Medicare UPIN