Provider Demographics
NPI:1922747054
Name:ELAYAN, TARICK NAEL (NP)
Entity Type:Individual
Prefix:
First Name:TARICK
Middle Name:NAEL
Last Name:ELAYAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35932 OLD HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2037
Mailing Address - Country:US
Mailing Address - Phone:313-399-6033
Mailing Address - Fax:
Practice Address - Street 1:35932 OLD HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2037
Practice Address - Country:US
Practice Address - Phone:313-399-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47043483363L00000X
MI4704348360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner