Healthcare Provider Details

I. General information

NPI: 1396690996
Provider Name (Legal Business Name): KHA TRAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9936 SW 57TH CT
OCALA FL
34476-0712
US

IV. Provider business mailing address

12901 BRUCE B DOWNS BLVD # 22
TAMPA FL
33612-4799
US

V. Phone/Fax

Practice location:
  • Phone: 352-300-8783
  • Fax:
Mailing address:
  • Phone: 813-974-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11047890
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN9504122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: