Provider Demographics
NPI:1417480310
Name:TAN, JESSICA (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5575 SIMMONS ST
Mailing Address - Street 2:UNIT 1 #563
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-9008
Mailing Address - Country:US
Mailing Address - Phone:702-304-2144
Mailing Address - Fax:
Practice Address - Street 1:2035 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2223
Practice Address - Country:US
Practice Address - Phone:702-304-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily