Provider Demographics
NPI:1568861342
Name:TIAN, NANCY (FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:TIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1011
Mailing Address - Country:US
Mailing Address - Phone:650-302-5864
Mailing Address - Fax:
Practice Address - Street 1:1149 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1011
Practice Address - Country:US
Practice Address - Phone:650-302-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP22677363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care