Provider Demographics
NPI:1114493186
Name:BELIMOVA, TATYANA (NP-C)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:BELIMOVA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 CRUMS MILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2889
Mailing Address - Country:US
Mailing Address - Phone:717-652-1051
Mailing Address - Fax:717-652-5027
Practice Address - Street 1:4250 CRUMS MILL RD STE 102
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2889
Practice Address - Country:US
Practice Address - Phone:717-652-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner