Provider Demographics
NPI:1275876260
Name:TRAN, AMY T (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 W WALNUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4017
Mailing Address - Country:US
Mailing Address - Phone:972-276-8688
Mailing Address - Fax:972-276-4473
Practice Address - Street 1:3555 W WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4017
Practice Address - Country:US
Practice Address - Phone:972-276-8688
Practice Address - Fax:972-276-4473
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04649OtherSTATE LICENSE