Healthcare Provider Details

I. General information

NPI: 1699448043
Provider Name (Legal Business Name): DARRIEN PHILLIP TRAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/14/2021
Certification Date: 08/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W RED BANK AVE
WOODBURY NJ
08096-1694
US

IV. Provider business mailing address

160 ELM AVE
WOODLYNNE NJ
08107-2250
US

V. Phone/Fax

Practice location:
  • Phone: 856-863-5720
  • Fax:
Mailing address:
  • Phone: 609-560-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01162500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: