Provider Demographics
NPI:1467102061
Name:RADOSAVLJEVIC, TATJANA
Entity Type:Individual
Prefix:
First Name:TATJANA
Middle Name:
Last Name:RADOSAVLJEVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5795 176 STREET
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BC
Mailing Address - Zip Code:V3S4E1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5795 176 STREET
Practice Address - Street 2:
Practice Address - City:SURREY
Practice Address - State:BC
Practice Address - Zip Code:V4A6X2
Practice Address - Country:CA
Practice Address - Phone:604-330-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642111163W00000X
ZZ0919828363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse