Healthcare Provider Details

I. General information

NPI: 1710849658
Provider Name (Legal Business Name): AMELIA TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 HOSPITAL DR
SPRUCE PINE NC
28777-3035
US

IV. Provider business mailing address

2188 MURRAY HILL RD APT 7
CLEVELAND OH
44106-2672
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-0110
  • Fax:
Mailing address:
  • Phone: 858-951-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: