Provider Demographics
NPI:1467712455
Name:KUVSHINIKOV, TATYANA N (PA-C)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:N
Last Name:KUVSHINIKOV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:N
Other - Last Name:BOVKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:814 KEEFUS RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-9784
Mailing Address - Country:US
Mailing Address - Phone:814-860-6416
Mailing Address - Fax:
Practice Address - Street 1:3315 N RIDGE RD E STE 700A
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4300
Practice Address - Country:US
Practice Address - Phone:440-484-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055473363A00000X
OH50.006454RX363A00000X
PAOA002842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant