Healthcare Provider Details

I. General information

NPI: 1902362122
Provider Name (Legal Business Name): MINH-CHAU THI TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34746-4754
US

IV. Provider business mailing address

5068 WHITEWATER WAY
SAINT CLOUD FL
34771-7970
US

V. Phone/Fax

Practice location:
  • Phone: 407-390-9431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: