Provider Demographics
NPI:1144995754
Name:TAN, ERIC (FNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GOLF VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7302
Mailing Address - Country:US
Mailing Address - Phone:848-992-4255
Mailing Address - Fax:
Practice Address - Street 1:35 BEAVERSON BLVD STE 6B
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7859
Practice Address - Country:US
Practice Address - Phone:732-262-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01177300363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care