Provider Demographics
NPI:1003948100
Name:DORAN, TATIANA D (FNP)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:D
Last Name:DORAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:812-735-3477
Practice Address - Street 1:103 WILLOW ST STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7605
Practice Address - Country:US
Practice Address - Phone:812-988-2223
Practice Address - Fax:812-988-3933
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001280A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201038760Medicaid
IN000000990238OtherANTHEM PIN
IN000000990238OtherANTHEM PIN
IN090200IMedicare UPIN
INQ31075Medicare UPIN