Provider Demographics
NPI:1447544176
Name:TACDERAS, ACE JAMES (NP)
Entity type:Individual
Prefix:MR
First Name:ACE
Middle Name:JAMES
Last Name:TACDERAS
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:17700 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1154
Mailing Address - Country:US
Mailing Address - Phone:586-868-9120
Mailing Address - Fax:586-868-9136
Practice Address - Street 1:17700 23 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1154
Practice Address - Country:US
Practice Address - Phone:586-868-9120
Practice Address - Fax:586-868-9136
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2015-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704234922363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health