Healthcare Provider Details

I. General information

NPI: 1407424716
Provider Name (Legal Business Name): ANH KHOA DIEU TRAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE TRAN PMHNP-BC, FNP-BC

II. Dates (important events)

Enumeration Date: 06/14/2021
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 TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10041775
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181558
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: