MEDICARE: THANH PHAN FNP

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	363LF0000X	Family Nurse Practitioner	221925	AZ

General Provider Information

NPI Number	:	1912858887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANH PHAN FNP

Provider Business Mailing Address
First Line	:	1630 N 26TH ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 N STAPLEY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-3002
Country	:	US
Telephone Number	:	480-834-7546
Fax Number	:	480-833-8313

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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