Provider Demographics
NPI:1629378443
Name:TRAN, ANITA TU (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:TU
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 HOCKANUM BLVD
Mailing Address - Street 2:UNIT 1626
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4056
Mailing Address - Country:US
Mailing Address - Phone:225-362-2420
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-236-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant