MEDICARE: THUC HOANG TRAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	9362350	FL
2	207Q00000X	Family Medicine Physician	9362350	FL
3	363LF0000X	Family Nurse Practitioner	9362350	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104333061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUC HOANG TRAN ARNP

Provider Business Mailing Address
First Line	:	5601 PENDLETON DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-7327
Country	:	US
Telephone Number	:	407-928-2229
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 PENDLETON DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-7327
Country	:	US
Telephone Number	:	407-928-2229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2018
Last Update Date	:	02/14/2019

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