Healthcare Provider Details

I. General information

NPI: 1316800147
Provider Name (Legal Business Name): TATJANA KAMENICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 DELAWARE AVE STE 2330
WILMINGTON DE
19806-4743
US

IV. Provider business mailing address

1207 DELAWARE AVE STE 2330
WILMINGTON DE
19806-4743
US

V. Phone/Fax

Practice location:
  • Phone: 888-736-0073
  • Fax:
Mailing address:
  • Phone: 888-736-0073
  • Fax: 717-754-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95307544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: