Provider Demographics
NPI:1972879062
Name:NASSERZADEH, TANNAZ (FNP)
Entity type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:NASSERZADEH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5150
Mailing Address - Country:US
Mailing Address - Phone:972-655-9595
Mailing Address - Fax:
Practice Address - Street 1:5401 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5150
Practice Address - Country:US
Practice Address - Phone:972-655-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX784343363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily