Provider Demographics
NPI:1407855430
Name:TRAN, ANN (PA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 GARDEN STONE LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2654
Mailing Address - Country:US
Mailing Address - Phone:813-748-8338
Mailing Address - Fax:813-884-5616
Practice Address - Street 1:5210 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4518
Practice Address - Country:US
Practice Address - Phone:813-882-9986
Practice Address - Fax:813-884-5616
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100696OtherMEDICAL LICENSE
FLP83616Medicare UPIN