Provider Demographics
NPI:1982833281
Name:TAN, IVY YING (FNP, DNP)
Entity Type:Individual
Prefix:MS
First Name:IVY
Middle Name:YING
Last Name:TAN
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:MS
Other - First Name:IVY
Other - Middle Name:YING
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP, DNP
Mailing Address - Street 1:5119 CAMINO AL NORTE STE 100
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2373
Mailing Address - Country:US
Mailing Address - Phone:702-625-8989
Mailing Address - Fax:702-331-3115
Practice Address - Street 1:5119 CAMINO AL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2373
Practice Address - Country:US
Practice Address - Phone:702-625-8989
Practice Address - Fax:702-331-3115
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583661163W00000X
CA19456363LF0000X
NV836053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19456OtherFAMILY NURSE PRACTITIONER
CA583661OtherRN LICENSE
NV836053OtherFAMILY NURSE PRACTITIONER