Provider Demographics
NPI:1083377568
Name:PHAN, THANH (APRN)
Entity Type:Individual
Prefix:MR
First Name:THANH
Middle Name:
Last Name:PHAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 RENNER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0051
Mailing Address - Country:US
Mailing Address - Phone:469-384-2989
Mailing Address - Fax:469-666-8180
Practice Address - Street 1:3447 RENNER RD STE 120
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0051
Practice Address - Country:US
Practice Address - Phone:469-384-2989
Practice Address - Fax:469-666-8180
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057298363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner