Provider Demographics
NPI:1659986735
Name:VALENTIN, TATYANA VLADIMIROVNA (AGACNP)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:VLADIMIROVNA
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7486 TOUR DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8109
Mailing Address - Country:US
Mailing Address - Phone:443-786-3384
Mailing Address - Fax:
Practice Address - Street 1:490 CADMUS LN STE 102
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4091
Practice Address - Country:US
Practice Address - Phone:410-770-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner