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General NPI Number Information
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NPI Number | 1467102061
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Entity Type | Individual
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Provider Name | TATJANA RADOSAVLJEVIC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 5795 176 STREET
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City | SURREY
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State | BC
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Zip | V4A6X2
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Country | CA
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Telephone | 604-330-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 5795 176 STREET
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City | SURREY
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State | BC
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Zip | V3S4E1
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 642111
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0919828
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License Number State | ZZ
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