Provider Demographics
NPI:1265860571
Name:TRAN, PHUONG (NP)
Entity type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STEPHANIE TRAN, NP
Mailing Address - Street 1:2770 AERO DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1519
Mailing Address - Country:US
Mailing Address - Phone:409-237-5133
Mailing Address - Fax:409-237-5162
Practice Address - Street 1:2770 AERO DR STE 3
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1519
Practice Address - Country:US
Practice Address - Phone:409-237-5133
Practice Address - Fax:409-237-5162
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342586YYSGMedicare PIN