Provider Demographics
NPI:1649699471
Name:KHAN, TATYANA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:ELIZABETH
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TATYANA
Other - Middle Name:ELIZABETH
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3941
Mailing Address - Fax:904-244-3020
Practice Address - Street 1:653 W 8TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3941
Practice Address - Fax:904-244-3020
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157695207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology