Provider Demographics
NPI:1538712716
Name:LE, PHUONG THAO THI (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:THAO THI
Last Name:LE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BEE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1322
Mailing Address - Country:US
Mailing Address - Phone:682-239-6122
Mailing Address - Fax:
Practice Address - Street 1:2840 LEGACY DR STE 210
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6053
Practice Address - Country:US
Practice Address - Phone:972-668-7110
Practice Address - Fax:972-668-7135
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily