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: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE A
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE A
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 315-547-0502
  • Fax: 727-382-0311
Mailing address:
  • Phone: 315-547-0502
  • Fax: 727-382-0311

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: ALICE TRAN
Title or Position: PMHNP
Credential: NP
Phone: 315-547-0502