Provider Demographics
NPI:1336570415
Name:SUVALIAN, TATIANA (NP)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:SUVALIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 KING MARK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5785
Mailing Address - Country:US
Mailing Address - Phone:603-438-3063
Mailing Address - Fax:
Practice Address - Street 1:1601 S. MOPAC EXPWY
Practice Address - Street 2:SUITE 450
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-329-9223
Practice Address - Fax:512-329-5632
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily