Provider Demographics
NPI:1477964971
Name:TANGONAN, ELIZA MAE (APN-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:MAE
Last Name:TANGONAN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2606
Mailing Address - Country:US
Mailing Address - Phone:201-360-1793
Mailing Address - Fax:
Practice Address - Street 1:74 ANDREW ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2606
Practice Address - Country:US
Practice Address - Phone:201-360-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00498900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner