Provider Demographics
NPI:1205387131
Name:OKHOTNIKOVA, TATYANA (NP IN PSYCHIATRY)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:OKHOTNIKOVA
Suffix:
Gender:F
Credentials:NP IN PSYCHIATRY
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:OKHOTNIKOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP IN PSYCHIATRY
Mailing Address - Street 1:9705 HORACE HARDING EXPY
Mailing Address - Street 2:APT 18G
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4157
Mailing Address - Country:US
Mailing Address - Phone:917-442-4290
Mailing Address - Fax:
Practice Address - Street 1:9705 HORACE HARDING EXPY
Practice Address - Street 2:APT 18G
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4157
Practice Address - Country:US
Practice Address - Phone:917-442-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health