Provider Demographics
NPI:1861876054
Name:NGUYEN, ANH (DPM)
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3937
Mailing Address - Country:US
Mailing Address - Phone:813-971-4678
Mailing Address - Fax:813-482-0036
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3937
Practice Address - Country:US
Practice Address - Phone:813-971-4678
Practice Address - Fax:813-978-8564
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPO3968213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2475OtherMEDICARE GROUP PTAN
FLM2505OtherMEDICARE PTAN
FL0244040700Medicaid
FLM2469OtherMEDICARE GROUP PTAN
FLPO3968OtherMEDICAL LICENSE
FLM2506OtherMEDICARE PTAN