Provider Demographics
NPI:1639694680
Name:GUREVICH, TATYANA (AGNP)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:GUREVICH
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6037
Mailing Address - Country:US
Mailing Address - Phone:972-679-1074
Mailing Address - Fax:
Practice Address - Street 1:870 N COIT RD STE 2660
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6215
Practice Address - Country:US
Practice Address - Phone:972-235-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134761363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health