Provider Demographics
NPI:1710201835
Name:GUIFARRO, TATYANA STEPHAN (PA)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:STEPHAN
Last Name:GUIFARRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:MATISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1050
Mailing Address - Country:US
Mailing Address - Phone:734-764-8320
Mailing Address - Fax:734-763-8030
Practice Address - Street 1:207 FLETCHER ST
Practice Address - Street 2:UNIVERSITY HEALTH SERVICE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-764-8320
Practice Address - Fax:734-763-8030
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant