Provider Demographics
NPI:1760732127
Name:TAN, NADEGE (NP)
Entity Type:Individual
Prefix:
First Name:NADEGE
Middle Name:
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 1:377 WILLARD ST STE 342
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6122
Mailing Address - Country:US
Mailing Address - Phone:857-246-9393
Mailing Address - Fax:980-500-2086
Practice Address - Street 1:140 WOOD RD STE 406
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2515
Practice Address - Country:US
Practice Address - Phone:857-246-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner