Provider Demographics
NPI:1902451404
Name:NGUYEN, ANH NGOC (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BRIDGESTONE WAY SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-6995
Mailing Address - Country:US
Mailing Address - Phone:706-331-6972
Mailing Address - Fax:
Practice Address - Street 1:78 OPAL ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2848
Practice Address - Country:US
Practice Address - Phone:770-382-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner