Provider Demographics
NPI:1629740527
Name:DYAKONOVA, TATIANA (CRNP)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:DYAKONOVA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:AUGUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:63 PITT ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2102
Mailing Address - Country:US
Mailing Address - Phone:570-486-4588
Mailing Address - Fax:570-486-4590
Practice Address - Street 1:531 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6754
Practice Address - Country:US
Practice Address - Phone:570-486-4588
Practice Address - Fax:570-486-4590
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily