Provider Demographics
NPI:1730376062
Name:ESTRADA, MELISSA TAN (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:TAN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1933 EDWIN DR STE 208
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6531
Mailing Address - Country:US
Mailing Address - Phone:757-252-5820
Mailing Address - Fax:
Practice Address - Street 1:1933 EDWIN DR STE 208
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6531
Practice Address - Country:US
Practice Address - Phone:757-252-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003688363LF0000X
VA0024170004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003688OtherSTATE LICENSE
VA0024170004OtherSTATE OF VIRGINIA