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General NPI Number Information
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NPI Number | 1679211015
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Entity Type | Individual
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Provider Name | CONNIE YI QING TAN NP
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1800 SULLIVAN AVE RM 101
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City | DALY CITY
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State | CA
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Zip | 94015-2227
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Country | US
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Telephone | 650-994-0459
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 JESSICA CIR
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City | FREMONT
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State | CA
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Zip | 94555-2102
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Country | US
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Telephone | 415-810-8684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95020349
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License Number State | CA
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