Provider Demographics
NPI:1033749270
Name:TAN, BERNICE (DNP NP)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:DNP NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N 13TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4973
Mailing Address - Country:US
Mailing Address - Phone:909-920-0525
Mailing Address - Fax:
Practice Address - Street 1:510 N 13TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4973
Practice Address - Country:US
Practice Address - Phone:909-920-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner