Provider Demographics
NPI:1477828614
Name:NYGAARD, TIANA NATAL (PA)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:NATAL
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5992 BERRYHILL RD
Mailing Address - Street 2:300
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-1013
Mailing Address - Country:US
Mailing Address - Phone:850-623-9787
Mailing Address - Fax:850-626-7512
Practice Address - Street 1:5992 BERRYHILL RD
Practice Address - Street 2:300
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1013
Practice Address - Country:US
Practice Address - Phone:850-623-9787
Practice Address - Fax:850-626-7512
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical