Provider Demographics
NPI:1710291844
Name:PESCOVA, TATYANA (AP)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:PESCOVA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 DYKES RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4663
Mailing Address - Country:US
Mailing Address - Phone:954-880-0090
Mailing Address - Fax:954-880-0026
Practice Address - Street 1:6840 DYKES RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-4663
Practice Address - Country:US
Practice Address - Phone:954-880-0090
Practice Address - Fax:954-880-0026
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2686171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist