Provider Demographics
NPI:1164144374
Name:ABRAHAMYAN, TIGRAN (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:TIGRAN
Middle Name:
Last Name:ABRAHAMYAN
Suffix:
Gender:M
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4643
Mailing Address - Country:US
Mailing Address - Phone:818-745-2002
Mailing Address - Fax:
Practice Address - Street 1:1100 E BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4643
Practice Address - Country:US
Practice Address - Phone:818-745-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily