Provider Demographics
NPI:1710751789
Name:DIEP, TRANG THUY
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:THUY
Last Name:DIEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 47TH AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-5121
Mailing Address - Country:US
Mailing Address - Phone:727-481-8062
Mailing Address - Fax:
Practice Address - Street 1:210 S MACDILL AVE # A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3131
Practice Address - Country:US
Practice Address - Phone:813-475-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB10009080106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician