Provider Demographics
NPI:1336865559
Name:CHEN, TUNGAN MARY (APRN)
Entity Type:Individual
Prefix:
First Name:TUNGAN
Middle Name:MARY
Last Name:CHEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7121
Mailing Address - Country:US
Mailing Address - Phone:321-726-2909
Mailing Address - Fax:
Practice Address - Street 1:601 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7121
Practice Address - Country:US
Practice Address - Phone:321-726-2909
Practice Address - Fax:321-984-4825
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily