Provider Demographics
NPI:1578922068
Name:TRAN, TAMMY (PNP, MSN, RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PNP, MSN, RN
Other - Prefix:
Other - First Name:TAM
Other - Middle Name:THI TO
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP, MSN, RN
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-4099
Mailing Address - Fax:714-509-3301
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-4099
Practice Address - Fax:714-509-3301
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525676163W00000X, 163WP0200X
CANP12849363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner