Provider Demographics
NPI:1386773489
Name:TAN, JOSE PENARANDA
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:PENARANDA
Last Name:TAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 W. ANDREW JOHNSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1027
Mailing Address - Country:US
Mailing Address - Phone:423-318-7800
Mailing Address - Fax:423-317-3332
Practice Address - Street 1:5250 W. ANDREW JOHNSON. HWY.
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1027
Practice Address - Country:US
Practice Address - Phone:423-318-7800
Practice Address - Fax:423-317-3332
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT00573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist