Healthcare Provider Details

I. General information

NPI: 1679449359
Provider Name (Legal Business Name): JASMINE-NICOLE TRAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17290 NEWHOPE ST STE B
FOUNTAIN VALLEY CA
92708-8205
US

IV. Provider business mailing address

200 FREEDOM LN
ALISO VIEJO CA
92656-5876
US

V. Phone/Fax

Practice location:
  • Phone: 949-522-1469
  • Fax: 714-455-7074
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037475
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95188410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: