Provider Demographics
NPI:1669183273
Name:TRAN, COLLEEN O (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:O
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 ALPHONSE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-1202
Mailing Address - Country:US
Mailing Address - Phone:504-756-6246
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3003
Practice Address - Country:US
Practice Address - Phone:504-454-2222
Practice Address - Fax:504-454-2388
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA334449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant