Provider Demographics
NPI:1831986710
Name:ESTAVIEN, TANYA (APRN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ESTAVIEN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 RIVER BEND RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-8099
Mailing Address - Country:US
Mailing Address - Phone:203-722-2272
Mailing Address - Fax:203-722-2272
Practice Address - Street 1:74 RIVER BEND RD UNIT B
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-8099
Practice Address - Country:US
Practice Address - Phone:203-722-2272
Practice Address - Fax:203-722-2272
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT14731363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology