Healthcare Provider Details

I. General information

NPI: 1811527542
Provider Name (Legal Business Name): LUANN PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 TAMIAMI TRL N STE 302A
NAPLES FL
34103-4457
US

IV. Provider business mailing address

26973 VILLANOVA CT
BONITA SPRINGS FL
34135-5036
US

V. Phone/Fax

Practice location:
  • Phone: 239-849-2667
  • Fax:
Mailing address:
  • Phone: 239-849-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: