Provider Demographics
NPI:1699594804
Name:LIMTIACO, TATSIANA
Entity type:Individual
Prefix:
First Name:TATSIANA
Middle Name:
Last Name:LIMTIACO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-5931
Mailing Address - Fax:
Practice Address - Street 1:7149 BLACKSHIP RUN RD
Practice Address - Street 2:FORT CAMPBELL, KY
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:270-798-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113746390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program