Provider Demographics
NPI:1881711828
Name:SANGOSANYA, TATIANA OSMA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:OSMA
Last Name:SANGOSANYA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3912
Mailing Address - Country:US
Mailing Address - Phone:727-443-6400
Mailing Address - Fax:
Practice Address - Street 1:612 DRUID RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1739
Practice Address - Country:US
Practice Address - Phone:727-443-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3357032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH525YOtherPTAN