Provider Demographics
NPI:1134770860
Name:VAN, SUONG THI (FNP)
Entity type:Individual
Prefix:
First Name:SUONG
Middle Name:THI
Last Name:VAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S COLORADO ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2707
Mailing Address - Country:US
Mailing Address - Phone:512-376-9690
Mailing Address - Fax:
Practice Address - Street 1:300 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2700
Practice Address - Country:US
Practice Address - Phone:512-376-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily