Provider Demographics
NPI:1750192860
Name:DARTHARD, TATIANA DEJANIE
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:DEJANIE
Last Name:DARTHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 BUCCANEER DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2009
Mailing Address - Country:US
Mailing Address - Phone:903-261-6458
Mailing Address - Fax:
Practice Address - Street 1:1904 BUCCANEER DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2009
Practice Address - Country:US
Practice Address - Phone:903-261-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator