Basic Information
| Provider Information | |||||||||
| NPI: | 1386179109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUONG | ||||||||
| FirstName: | NGOC | ||||||||
| MiddleName: | BICH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 COCONUT PALM DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336198362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883132150 | ||||||||
| FaxNumber: | 8655607088 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 COCONUT PALM DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336198362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883132150 | ||||||||
| FaxNumber: | 8655607088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2017 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA 9110335 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.