Provider Demographics
NPI:1235466517
Name:SADAK, TATIANA (ARNP)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:SADAK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 191ST PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5069
Mailing Address - Country:US
Mailing Address - Phone:206-459-1158
Mailing Address - Fax:888-296-8140
Practice Address - Street 1:110 JAMES ST
Practice Address - Street 2:STE 104
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-8430
Practice Address - Country:US
Practice Address - Phone:206-459-1158
Practice Address - Fax:888-296-8140
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-07
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60122579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health