Provider Demographics
NPI:1013927045
Name:WARNER, TATIANA M (PA)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:M
Last Name:WARNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:3325 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7913
Practice Address - Country:US
Practice Address - Phone:775-887-5140
Practice Address - Fax:775-884-3618
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013927045Medicaid
NVP95556Medicare UPIN