| Waters Medical Clinic, Llc | |
|
4040 W Waters Ave Suite 103 Tampa FL 33614-1958 | |
| (813) 885-9091 | |
| (813) 885-3527 |
| Full Name | Waters Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4040 W Waters Ave, Tampa, Florida |
| Authorized Official Name and Position | Thanhmy T Nguyen (OPERATING MANAGER) |
| Authorized Official Contact | 8138859091 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waters Medical Clinic, Llc Po Box 261825 Tampa FL 33685-1825 Ph: (813) 885-9091 | Waters Medical Clinic, Llc 4040 W Waters Ave Suite 103 Tampa FL 33614-1958 Ph: (813) 885-9091 |
| NPI Number | 1336467208 |
|---|---|
| Provider Enumeration Date | 05/17/2010 |
| Last Update Date | 11/23/2012 |
| Medicare PECOS PAC ID | 0648454876 |
|---|---|
| Medicare Enrollment ID | O20110412000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336467208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Thanhmy Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285624759 PECOS PAC ID: 6406846179 Enrollment ID: I20050620000225 |
| Provider Name | Andrew V. Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689233058 PECOS PAC ID: 3971839960 Enrollment ID: I20190730000080 |
| Provider Name | Thuyan Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164053658 PECOS PAC ID: 6608205075 Enrollment ID: I20200406002457 |
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