Individual
JACQUELYN DAN-PHUNG NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2103 LANTERN LN, ORELAND, PA 19075-2513
(901) 641-3000
(901) 373-0804
Mailing address
2103 LANTERN LN, ORELAND, PA 19075-2513
(267) 626-1377
(267) 626-1377
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
4276
TN
363AS0400X
Surgical Physician Assistant
Primary
4276
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1157550
NCCPA
TN
01
—
4276
PHYSICIAN ASSISTANT
TN
Enumeration date
09/16/2020
Last updated
03/06/2023
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