1710434550 NPI number — THU TAM THU LE APRN

Table of content: THU TAM THU LE APRN (NPI 1710434550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710434550 NPI number — THU TAM THU LE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
THU TAM
Provider Middle Name:
THU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710434550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10841 LITTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34654-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-619-0180
Provider Business Mailing Address Fax Number:
727-861-4816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10841 LITTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34654-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-619-0180
Provider Business Practice Location Address Fax Number:
727-861-4816
Provider Enumeration Date:
09/09/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SG0600X , with the licence number:  ARNP 9227173 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: ARNP 9227173 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)