Provider Demographics
NPI:1104574235
Name:TAN, ARA DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:DENISE
Last Name:TAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ARA DENISE
Other - Middle Name:FARAON
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2300 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4121
Mailing Address - Country:US
Mailing Address - Phone:336-837-8369
Mailing Address - Fax:
Practice Address - Street 1:23456 HAWTHORNE BLVD # 240
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:888-777-1945
Practice Address - Fax:805-413-9099
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner