Active NPI
Thanh Nguyen, PA
- Medical Physician Assistant
- Jacksonville, FL
National Provider Identifier
1497680276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 5602 Luella St
Jacksonville, FL 32207-5920 - Phone
- (904) 572-5303
- NPI assigned
- Jun 15, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
5602 Luella St
Jacksonville, FL 32207-5920
Mailing address
5602 Luella St
Jacksonville, FL 32207-5920
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1781481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1497680276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5602 LUELLA ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322075920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5602 LUELLA ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322075920",
"telephone_number": "904-572-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "THANH",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-06-15",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.