Provider Demographics
NPI:1649155045
Name:NGUYEN, TANGNEKA MIRACLE (PA-C)
Entity type:Individual
Prefix:
First Name:TANGNEKA
Middle Name:MIRACLE
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 1:100 W WATER ST APT 405
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3011
Mailing Address - Country:US
Mailing Address - Phone:717-377-5392
Mailing Address - Fax:
Practice Address - Street 1:950 COUNTY ROAD 64 STE 100
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-9711
Practice Address - Country:US
Practice Address - Phone:607-796-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034250207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology