Provider Demographics
NPI:1245943760
Name:TRAN, THAO NGOC PHUONG (FNP)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:NGOC PHUONG
Last Name:TRAN
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 1:4485 THISTLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2051
Mailing Address - Country:US
Mailing Address - Phone:408-620-2320
Mailing Address - Fax:
Practice Address - Street 1:4485 THISTLE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2051
Practice Address - Country:US
Practice Address - Phone:408-620-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023688363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care