Provider Demographics
NPI:1992134944
Name:TAN, TERESA (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147-45 69TH ROAD
Mailing Address - Street 2:2ND FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-570-7341
Mailing Address - Fax:
Practice Address - Street 1:1809 NOSTRAND AVE
Practice Address - Street 2:2ND FLOOR SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7181
Practice Address - Country:US
Practice Address - Phone:718-421-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-09
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668914163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse