Provider Demographics
NPI:1861222911
Name:NGUYEN, KHAAI TRAN (PA-C)
Entity type:Individual
Prefix:
First Name:KHAAI
Middle Name:TRAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-7491
Mailing Address - Country:US
Mailing Address - Phone:904-880-0622
Mailing Address - Fax:904-880-0623
Practice Address - Street 1:1807 3RD ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-7491
Practice Address - Country:US
Practice Address - Phone:904-880-0622
Practice Address - Fax:904-880-0623
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119912363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant