Provider Demographics
NPI:1033657333
Name:TANG, QIAN (NP)
Entity type:Individual
Prefix:MRS
First Name:QIAN
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2029
Mailing Address - Country:US
Mailing Address - Phone:912-871-5000
Mailing Address - Fax:912-681-1444
Practice Address - Street 1:106 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2459
Practice Address - Country:US
Practice Address - Phone:912-871-5000
Practice Address - Fax:912-681-1444
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner