Provider Demographics
NPI:1780658500
Name:TRAN, TRI TU (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TRI
Middle Name:TU
Last Name:TRAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 OLD CAMP RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-259-5960
Mailing Address - Fax:352-750-1854
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:SUITE 202
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-259-5960
Practice Address - Fax:352-750-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101733363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291141800Medicaid
FLE6462MMedicare PIN
FL291141800Medicaid
E6462XMedicare PIN