Healthcare Provider Details

I. General information

NPI: 1306786504
Provider Name (Legal Business Name): ALICE TRAN NURSE PRACTITIONER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 WILLIAMS DR STE 300
FAIRFAX VA
22031-4648
US

IV. Provider business mailing address

3060 WILLIAMS DR STE 300
FAIRFAX VA
22031-4648
US

V. Phone/Fax

Practice location:
  • Phone: 703-791-9099
  • Fax: 804-807-9399
Mailing address:
  • Phone: 703-791-9099
  • Fax: 804-807-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANH KHOA DIEU TRAN
Title or Position: OWNER
Credential:
Phone: 703-791-9099