Healthcare Provider Details

I. General information

NPI: 1023367356
Provider Name (Legal Business Name): NADIA TIKHOMIROVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST
ACTON MA
01720-3799
US

IV. Provider business mailing address

321 MAIN ST
ACTON MA
01720-3799
US

V. Phone/Fax

Practice location:
  • Phone: 978-635-8700
  • Fax:
Mailing address:
  • Phone: 978-635-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2263046
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: