Individual provider Active NPI

Tien T Nguyen, NP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1700361276
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00846100 Issued in NJ
Practice address
6431 Sackett St
Philadelphia, PA 19149-3118
Phone
(267) 448-4908
Fax
(267) 297-3950
NPI assigned
Oct 1, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00846100 NJ Primary

Addresses

Primary practice location

6431 Sackett St
Philadelphia, PA 19149-3118

Mailing address

6431 Sackett St
Philadelphia, PA 19149-3118
Phone (267) 448-4908

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190321000877 NJ Practitioner - Nurse Practitioner 2961742333 Reassigns benefits to 2 organizations
I20210128000007 PA Practitioner - Nurse Practitioner 2961742333 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Director Services PC CurrentSince Aug 1, 2020 Accepting new patients
Nurse Practitioner Professional Resources CurrentSince Feb 1, 2020 Accepting new patients
Dedicated Pennsylvania Holding, LLC Family Medicine CurrentSince Feb 1, 2021 Accepting new patients
Dedicated Pennsylvania Holding, LLC CurrentSince Feb 1, 2021 Accepting new patients
Dedicated Pennsylvania Holding, LLC Past Accepting new patients
Atlantic Hospice, Inc. Family Medicine PastSince Feb 4, 2019 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

43 N White Horse Pike
Hammonton, NJ 08037
Phone (609) 567-3100

330 W Oregon Ave
Ste 170
Philadelphia, PA 19148
Phone (267) 338-3411

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26288/brand/1/csg/1/fhir/r4

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1700361276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6431 SACKETT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191493118",
            "telephone_number": "267-448-4908",
            "fax_number": "267-297-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 SACKETT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191493118",
            "telephone_number": "267-448-4908",
            "fax_number": "267-297-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "TIEN",
        "middle_name": "T",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00846100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.