Provider Demographics
NPI:1689667636
Name:TAT, SHELLY MILLER (ACNP, MHA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MILLER
Last Name:TAT
Suffix:
Gender:F
Credentials:ACNP, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 CENTER AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9152
Mailing Address - Country:US
Mailing Address - Phone:657-204-3953
Mailing Address - Fax:844-698-7227
Practice Address - Street 1:7755 CENTER AVE STE 630
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9152
Practice Address - Country:US
Practice Address - Phone:657-204-3953
Practice Address - Fax:844-698-7227
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN133463363LA2100X
CA11304363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care