Provider Demographics
NPI:1578159968
Name:TIHOMIROVS, NADEJDA (NP)
Entity Type:Individual
Prefix:
First Name:NADEJDA
Middle Name:
Last Name:TIHOMIROVS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 OCEANA DR E APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6684
Mailing Address - Country:US
Mailing Address - Phone:917-922-0929
Mailing Address - Fax:
Practice Address - Street 1:3000 OCEAN PKWY STE L1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8344
Practice Address - Country:US
Practice Address - Phone:718-283-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3110044363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty