Healthcare Provider Details

I. General information

NPI: 1568188332
Provider Name (Legal Business Name): JACQUELINE MINH TRAN FNP-BC, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 WREN AVE
GILROY CA
95020-7636
US

IV. Provider business mailing address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-1017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95277214
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: