Healthcare Provider Details

I. General information

NPI: 1568244200
Provider Name (Legal Business Name): SALLY TAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 CREEKSIDE DR STE 200
FOLSOM CA
95630-3888
US

IV. Provider business mailing address

1580 CREEKSIDE DR STE 200
FOLSOM CA
95630-3888
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-0340
  • Fax:
Mailing address:
  • Phone: 916-924-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95026988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: