Provider Demographics
NPI:1588121578
Name:TRAN, MAI THI
Entity type:Individual
Prefix:MS
First Name:MAI
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAI
Other - Middle Name:T
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1404 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2554
Mailing Address - Country:US
Mailing Address - Phone:228-575-2870
Mailing Address - Fax:
Practice Address - Street 1:1404 44TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2554
Practice Address - Country:US
Practice Address - Phone:228-575-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01191804OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
MS903187OtherMS BOARD OF NURSING