Provider Demographics
NPI:1235674276
Name:TRAN, DANIELLE CHRISTINE (PA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHRISTINE
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4815 BEREWICK TOWN CENTER DR STE C&D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6733
Practice Address - Country:US
Practice Address - Phone:980-337-4652
Practice Address - Fax:980-337-4653
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-09178OtherNC MEDICAL LICENSE
NC1134084OtherPA-C LICENSE