Healthcare Provider Details

I. General information

NPI: 1104094945
Provider Name (Legal Business Name): TAK LUNG RAYMOND TANG APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 BLOUNT RD
POMPANO BEACH FL
33069-1118
US

IV. Provider business mailing address

12300 NW 10TH ST
PLANTATION FL
33323-2504
US

V. Phone/Fax

Practice location:
  • Phone: 954-831-3527
  • Fax:
Mailing address:
  • Phone: 954-530-2660
  • Fax: 954-530-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3395302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: