Provider Demographics
NPI:1922534684
Name:NGUYEN, CHRISTELLE T (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTELLE
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 38TH AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1263
Mailing Address - Country:US
Mailing Address - Phone:727-345-1332
Mailing Address - Fax:727-345-3200
Practice Address - Street 1:7655 38TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1263
Practice Address - Country:US
Practice Address - Phone:727-345-1332
Practice Address - Fax:727-345-3200
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017572207Q00000X
FLOS17012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMV737OtherMEDICARE
FL107519600Medicaid
FL107519600Medicaid