Provider Demographics
NPI:1255960373
Name:ATRUKTSANG, TENZIN SONAM
Entity type:Individual
Prefix:
First Name:TENZIN
Middle Name:SONAM
Last Name:ATRUKTSANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TENZIN
Other - Middle Name:
Other - Last Name:SONAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5779
Mailing Address - Country:US
Mailing Address - Phone:813-916-2349
Mailing Address - Fax:
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:813-916-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program