Provider Demographics
NPI:1033184536
Name:OLSON, TATIANA CARLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:CARLIN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:LARISSA
Other - Last Name:CARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:510 W TUDOR RD
Mailing Address - Street 2:STE 5
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6649
Mailing Address - Country:US
Mailing Address - Phone:907-743-0050
Mailing Address - Fax:907-743-0060
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-458-2682
Practice Address - Fax:907-458-2628
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020150Medicaid
MC1133331OtherDEA NUMBER
AK0361450001Medicare NSC
MC1133331OtherDEA NUMBER
AKK166215Medicare PIN