Healthcare Provider Details

I. General information

NPI: 1952808800
Provider Name (Legal Business Name): TYANNE TUYEN VAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W WARNER RD STE 3
CHANDLER AZ
85224-2634
US

IV. Provider business mailing address

1901 W WARNER RD STE 3
CHANDLER AZ
85224-2634
US

V. Phone/Fax

Practice location:
  • Phone: 602-617-8390
  • Fax:
Mailing address:
  • Phone: 602-617-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11121
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP11121
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: