Healthcare Provider Details

I. General information

NPI: 1093974776
Provider Name (Legal Business Name): NANCY MY NGOC TRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N FLAMINGO RD STE 265
PEMBROKE PINES FL
33028-1013
US

IV. Provider business mailing address

603 N FLAMINGO RD STE 265
PEMBROKE PINES FL
33028-1013
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-9008
  • Fax: 954-986-6646
Mailing address:
  • Phone: 954-986-9008
  • Fax: 954-986-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME117522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: