Provider Demographics
NPI:1679025571
Name:TRAN, TAM THU (PA-C)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:THU
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1779
Mailing Address - Country:US
Mailing Address - Phone:772-800-3037
Mailing Address - Fax:772-807-1409
Practice Address - Street 1:22864 NEPTUNE ROAD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:754-204-8753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109814363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical