Healthcare Provider Details

I. General information

NPI: 1205766078
Provider Name (Legal Business Name): XANDRIA MARIA RUSIANA-TRAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 IH 10 N STE 112
BEAUMONT TX
77707-2560
US

IV. Provider business mailing address

538 BROADWAY
WINNIE TX
77665-7600
US

V. Phone/Fax

Practice location:
  • Phone: 409-239-5139
  • Fax: 409-347-8856
Mailing address:
  • Phone: 409-981-5500
  • Fax: 409-312-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1234598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: