Provider Demographics
NPI:1710002266
Name:TATIANA NAGIBINA MD PA
Entity Type:Organization
Organization Name:TATIANA NAGIBINA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAGIBINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-734-1530
Mailing Address - Street 1:646 VIRGINIA ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6612
Mailing Address - Country:US
Mailing Address - Phone:727-734-1530
Mailing Address - Fax:727-734-1570
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-734-1530
Practice Address - Fax:727-734-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81965261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6348Medicare ID - Type Unspecified
FLH45956Medicare UPIN