Provider Demographics
NPI:1932416625
Name:TAN, MELISSA C (RN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:C
Last Name:TAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4330 MEDICAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3353
Mailing Address - Country:US
Mailing Address - Phone:210-237-4330
Mailing Address - Fax:210-616-0509
Practice Address - Street 1:6800 PARK TEN BLVD STE 154-E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4243
Practice Address - Country:US
Practice Address - Phone:210-828-2503
Practice Address - Fax:210-828-0590
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX537889163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse