Individual
LOI TRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-1622
(215) 707-0943
Mailing address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-3911
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP035311
PA
363LA2100X
Acute Care Nurse Practitioner
APRN11004811
FL
363LA2100X
Acute Care Nurse Practitioner
Primary
SP035311
PA
Other
Enumeration date
07/10/2014
Last updated
05/12/2026
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