Healthcare Provider Details

I. General information

NPI: 1124779731
Provider Name (Legal Business Name): HAO TRAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-45 MAIN STREET
FLUSHING NY
11355
US

IV. Provider business mailing address

12950 EAGLE RD
CAPE CORAL FL
33909-3006
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2000
  • Fax:
Mailing address:
  • Phone: 239-691-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number137073
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number754700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: