MEDICARE: JENNIFER TEDERA TAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	26NJ15228700	NJ
2	363LA2100X	Acute Care Nurse Practitioner	26NJ15228700	NJ
3	363L00000X	Nurse Practitioner	26NJ15228700	NJ

General Provider Information

NPI Number	:	1083429070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TEDERA TAN APN

Provider Business Mailing Address
First Line	:	94 OLD SHORT HILLS RD
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5672
Country	:	US
Telephone Number	:	973-978-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 OLD SHORT HILLS RD
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5672
Country	:	US
Telephone Number	:	973-322-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2025
Last Update Date	:	01/09/2026

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