Provider Demographics
NPI:1205479912
Name:BAO, TANA (MSN FNP-BC NP-C APRN)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:BAO
Suffix:
Gender:F
Credentials:MSN FNP-BC NP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 ELM ST STE D
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1818
Mailing Address - Country:US
Mailing Address - Phone:508-433-3687
Mailing Address - Fax:508-283-1414
Practice Address - Street 1:1275 ELM ST STE D
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1818
Practice Address - Country:US
Practice Address - Phone:508-433-3687
Practice Address - Fax:508-283-1414
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily