Provider Demographics
NPI:1104094945
Name:TANG, TAK LUNG RAYMOND (APRN)
Entity type:Individual
Prefix:MR
First Name:TAK LUNG
Middle Name:RAYMOND
Last Name:TANG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2504
Mailing Address - Country:US
Mailing Address - Phone:954-530-2660
Mailing Address - Fax:954-530-2660
Practice Address - Street 1:1550 BLOUNT RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1118
Practice Address - Country:US
Practice Address - Phone:954-831-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3395302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily