Provider Demographics
NPI:1831595453
Name:TIKHONOV, DEANNA (APN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:TIKHONOV
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:125 PATERSON STREET
Mailing Address - Street 2:CLINICAL ACADEMIC BUILDING SUITE 4200
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1977
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON STREET
Practice Address - Street 2:ACADEMIC BUILDING SUITE 4200
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1977
Practice Address - Country:US
Practice Address - Phone:732-235-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00531400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health