Individual
NATALIA HANDRAYANI TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 890, FORT WORTH, TX 76104-2145
(817) 250-4280
(817) 250-4281
Mailing address
1325 PENNSYLVANIA AVE STE 890, FORT WORTH, TX 76104-2145
(817) 250-4280
(817) 250-4281
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA07379
TX
363AS0400X
Surgical Physician Assistant
Primary
PA07379
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285353305
—
TX
05
—
285353306
—
TX
Enumeration date
09/26/2011
Last updated
04/06/2017
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