Individual
AGNES TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2699 ATLANTIC AVE, LONG BEACH, CA 90806-2710
(562) 988-7383
Mailing address
2699 ATLANTIC AVE, LONG BEACH, CA 90806-2710
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95004938
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95004938
NURSE PRACTITIONER LICENSE
CA
Enumeration date
09/12/2016
Last updated
12/06/2021
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