Provider Demographics
NPI:1346851417
Name:TVRDIK, TATIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:TVRDIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:BASTLOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2830 S 2750 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2017
Mailing Address - Country:US
Mailing Address - Phone:801-739-2651
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-712-4810
Practice Address - Fax:404-712-4349
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247ZC0005X
GA20027SP247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician