Provider Demographics
NPI:1144711094
Name:TAN, NANCY K
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:TAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 VILLA CREEK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7374
Mailing Address - Country:US
Mailing Address - Phone:469-904-8364
Mailing Address - Fax:469-904-8378
Practice Address - Street 1:2655 VILLA CREEK DR STE 110
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7374
Practice Address - Country:US
Practice Address - Phone:469-904-8364
Practice Address - Fax:469-904-8378
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based