Healthcare Provider Details

I. General information

NPI: 1477056356
Provider Name (Legal Business Name): ANIWELYN TAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N HIGHLAND AVE
SHERMAN TX
75092-7377
US

IV. Provider business mailing address

425 N HIGHLAND AVE STE 260
SHERMAN TX
75092-7377
US

V. Phone/Fax

Practice location:
  • Phone: 903-957-0082
  • Fax:
Mailing address:
  • Phone: 903-957-0082
  • Fax: 903-957-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP136524
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP136524
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: