Individual
THANH M NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12086 FORT CAROLINE RD, STE 401, JACKSONVILLE, FL 32225-2687
(904) 565-1271
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME101652
FL
2080P0205X
Pediatric Endocrinology Physician
Primary
ME101652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000031000
—
FL
01
—
41503
BCBS / FLORIDA BLUE
FL
Enumeration date
09/20/2006
Last updated
11/06/2015
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