Provider Demographics
NPI:1043841539
Name:KHARINA, TATIANA (NP)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KHARINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:KHARINA-MUYIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:16 STREAM CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1544
Practice Address - Country:US
Practice Address - Phone:860-863-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6468721163W00000X
CT9522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse