Provider Demographics
NPI:1841701984
Name:TRAN, TAM NUMINH (AGNP-C)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:NUMINH
Last Name:TRAN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17370 PRESTON RD STE 412
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5611
Mailing Address - Country:US
Mailing Address - Phone:972-503-5459
Mailing Address - Fax:
Practice Address - Street 1:17370 PRESTON RD STE 412
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5611
Practice Address - Country:US
Practice Address - Phone:972-503-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner