Provider Demographics
NPI:1760130421
Name:SRYBNYKH, TATYANA DMITRIEVNA (PA-C)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:DMITRIEVNA
Last Name:SRYBNYKH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 OXFORD CREST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1536
Mailing Address - Country:US
Mailing Address - Phone:904-588-3358
Mailing Address - Fax:
Practice Address - Street 1:8 OFFICE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3808
Practice Address - Country:US
Practice Address - Phone:720-679-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9115662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant