Provider Demographics
NPI:1477828614
Name:NYGAARD, TIANA NATAL (PA)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:NATAL
Last Name:NYGAARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3037
Mailing Address - Country:US
Mailing Address - Phone:631-513-1766
Mailing Address - Fax:
Practice Address - Street 1:45 INDUSTRIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7668
Practice Address - Country:US
Practice Address - Phone:850-290-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical