Individual
BAO-KHUYEN NGUYEN LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13670 WALSINGHAM RD, LARGO, FL 33774-3532
(727) 593-9848
Mailing address
11921 N DALE MABRY HWY, TAMPA, FL 33618-3512
(813) 609-3635
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9112468
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108286600
—
FL
Enumeration date
11/18/2019
Last updated
04/17/2023
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