Provider Demographics
NPI:1225876345
Name:DANG, LIEN TRACY (APRN)
Entity type:Individual
Prefix:MISS
First Name:LIEN
Middle Name:TRACY
Last Name:DANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 LEWIS MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-8560
Mailing Address - Country:US
Mailing Address - Phone:941-268-1689
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4331
Practice Address - Country:US
Practice Address - Phone:904-222-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily