Individual provider Active NPI

Thao Nguyen Le Tran, APRN

  • Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1801540695
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11016791 Issued in FL
Practice address
841 Prudential Dr Ste 280
Jacksonville, FL 32207-8329
Phone
(904) 202-8550
Fax
(904) 393-7808
NPI assigned
Feb 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11016791 FL
Family Nurse Practitioner 363LF0000X APRN11016791 FL
Nurse Practitioner 363L00000X APRN11016791 FL Primary

Addresses

Primary practice location

841 Prudential Dr Ste 280
Jacksonville, FL 32207-8329

Mailing address

PO Box 746645
Atlanta, GA 30374-6645
Phone (904) 376-4083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220317002113 FL Practitioner - Nurse Practitioner 0547655151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivx Health of Florida PAGroup PAC ID 8426470626, 47 clinicians

Practice addresses (Care Compare)

10400 San Jose Blvd
Suite 13
Jacksonville, FL 32257-6363
Phone (904) 339-7332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11016791FLMDNurse Practitioner
11016791FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Specialty Physicians Inc CurrentSince Aug 28, 2022 Accepting new patients
Ivx Health of Florida, P.a. CurrentSince Feb 21, 2022 Accepting new patients
Infusion Express of Kansas LLC Past Accepting new patients

Locations

293 E Altamonte Dr
Ste 1201
Altamonte Springs, FL 32701
Phone (407) 392-3171

9734 Deer Lake Ct
Ste 6
Jacksonville, FL 32246
Phone (904) 339-7341

4509 Saint Johns Ave
Ste 4
Jacksonville, FL 32210
Phone (904) 339-7334

10400 San Jose Blvd
Ste 13
Jacksonville, FL 32257
Phone (904) 339-7331

586 Marsh Landing Pkwy
Jacksonville Beach, FL 32250
Phone (904) 478-8441

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1801540695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746645",
            "telephone_number": "904-376-4083",
            "fax_number": "904-391-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 280",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078329",
            "telephone_number": "904-202-8550",
            "fax_number": "904-393-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "THAO",
        "middle_name": "NGUYEN LE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11016791",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11016791",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11016791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.