Provider Demographics
NPI:1710320031
Name:TAN, NORALDA QUITAIN (MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:NORALDA
Middle Name:QUITAIN
Last Name:TAN
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27341 ROSE MALLOW LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6954
Mailing Address - Country:US
Mailing Address - Phone:661-645-9357
Mailing Address - Fax:661-367-4571
Practice Address - Street 1:27341 ROSE MALLOW LN
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-6954
Practice Address - Country:US
Practice Address - Phone:661-645-9357
Practice Address - Fax:661-367-4571
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 22780363LF0000X
CANP 22780363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily