Provider Demographics
NPI:1164285045
Name:WALDON, TATIANA SIOBHAN HOOVER (PA)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:SIOBHAN HOOVER
Last Name:WALDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:915 DILLS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-5319
Mailing Address - Country:US
Mailing Address - Phone:803-221-9567
Mailing Address - Fax:
Practice Address - Street 1:915 DILLS BLUFF RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-5319
Practice Address - Country:US
Practice Address - Phone:803-221-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant