Provider Demographics
NPI:1831662477
Name:TAN, MARIA CECILIA SABANDAL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIA CECILIA
Middle Name:SABANDAL
Last Name:TAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9976 ASILOMAR LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2549
Mailing Address - Country:US
Mailing Address - Phone:916-718-0101
Mailing Address - Fax:
Practice Address - Street 1:2200 DEL PASO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3102
Practice Address - Country:US
Practice Address - Phone:916-924-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95059192163W00000X
CA95011241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse