Provider Demographics
NPI:1538669627
Name:TRAN, RATCHADAKON (APRN)
Entity type:Individual
Prefix:MRS
First Name:RATCHADAKON
Middle Name:
Last Name:TRAN
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 1:4654 E STATE ROAD 64 STE 267
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9029
Mailing Address - Country:US
Mailing Address - Phone:813-448-7998
Mailing Address - Fax:888-392-8649
Practice Address - Street 1:3379 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7245
Practice Address - Country:US
Practice Address - Phone:813-448-7998
Practice Address - Fax:888-392-8649
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9413084363L00000X, 363LF0000X
FLF02180533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100003500Medicaid
FLAPRN9413084OtherFL LICENSE
FLUZ2T5OtherBCBS
FLUZ2T5OtherBCBS