Provider Demographics
NPI:1093974057
Name:BARSUKOVA, TATIANA VASYLIEVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:VASYLIEVNA
Last Name:BARSUKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:YAKOUSHINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-391-1330
Practice Address - Fax:904-391-1319
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43197207Q00000X, 207QA0401X
TX43197207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB116506Medicare PIN