Active NPI
Yingjie Tan
- Pharmacist
- Port St John, FL
National Provider Identifier
1104497676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS62119
- Practice address
- 6257 N US Highway 1
Port St John, FL 32927-4925 - Phone
- (321) 633-8150
- NPI assigned
- Jul 7, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS62119 | FL | Primary |
Addresses
Primary practice location
6257 N US Highway 1
Port St John, FL 32927-4925
Mailing address
282 Erin LN
Rockledge, FL 32955-5633
Phone (321) 266-0239
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS62119 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625616000000",
"number": "1104497676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "282 ERIN LN",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329555633",
"telephone_number": "321-266-0239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6257 N US HIGHWAY 1",
"city": "PORT ST JOHN",
"state": "FL",
"postal_code": "329274925",
"telephone_number": "321-633-8150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "YINGJIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-07",
"last_updated": "2021-07-07",
"certification_date": "2021-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS62119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St John, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.