=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215296678
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRANTRAN T NGUYEN D.O
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2012
-----------------------------------------------------
Last Update Date | 06/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 36TH ST INDIAN RIVER MEDICAL CENTER
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-567-4311
-----------------------------------------------------
Fax | 772-563-4641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 36TH ST INDIAN RIVER MEDICAL CENTER
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-567-4311
-----------------------------------------------------
Fax | 772-563-4641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OT014613
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | OS13369
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------