Healthcare Provider Details

I. General information

NPI: 1598502981
Provider Name (Legal Business Name): THERESA TRAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N MACDILL AVE
TAMPA FL
33607-2205
US

IV. Provider business mailing address

9152 FOX SPARROW RD
TAMPA FL
33626-2653
US

V. Phone/Fax

Practice location:
  • Phone: 813-280-0202
  • Fax:
Mailing address:
  • Phone: 804-357-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: