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NPI Code Detail

MEDICARE: MS. IVY YING TAN FNP, DNP

MEDICARE: MS. IVY YING TAN FNP, DNP
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
1163W00000XRegistered Nurse583661CA
2363LF0000XFamily Nurse Practitioner19456CA
3363LF0000XFamily Nurse Practitioner836053NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119456OTHERCAFAMILY NURSE PRACTITIONER
2583661OTHERCARN LICENSE
3836053OTHERNVFAMILY NURSE PRACTITIONER

General Provider Information

NPI Number : 1982833281
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IVY YING TAN FNP, DNP
Provider Business Mailing Address
First Line : 5119 CAMINO AL NORTE STE 100
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89031-2373
Country : US
Telephone Number : 702-625-8989
Fax Number : 702-331-3115
Provider Business Practice Location Address
First Line : 5119 CAMINO AL NORTE STE 100
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-2373
Country : US
Telephone Number : 702-625-8989
Fax Number : 702-331-3115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2009
Last Update Date : 11/28/2023

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