Provider Demographics
NPI:1255792875
Name:CHEN, TAMMY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:150 LAGUNA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92535-3614
Mailing Address - Country:US
Mailing Address - Phone:714-525-8822
Mailing Address - Fax:714-525-5193
Practice Address - Street 1:150 LAGUNA RD STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3614
Practice Address - Country:US
Practice Address - Phone:714-525-8822
Practice Address - Fax:714-525-5193
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95003688363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health