Provider Demographics
NPI:1962179911
Name:DOAN-PHAM, JENNIFER THANH (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THANH
Last Name:DOAN-PHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W SPRING CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4103
Mailing Address - Country:US
Mailing Address - Phone:972-943-0601
Mailing Address - Fax:
Practice Address - Street 1:2101 W SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4103
Practice Address - Country:US
Practice Address - Phone:972-943-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily