Provider Demographics
NPI:1679211015
Name:TAN, CONNIE YI QING (NP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:YI QING
Last Name:TAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 JESSICA CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2102
Mailing Address - Country:US
Mailing Address - Phone:415-810-8684
Mailing Address - Fax:
Practice Address - Street 1:1800 SULLIVAN AVE RM 101
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2227
Practice Address - Country:US
Practice Address - Phone:650-994-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily