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General NPI Number Information
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NPI Number | 1760130421
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Entity Type | Individual
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Provider Name | TATYANA DMITRIEVNA SRYBNYKH PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/12/2022
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 8 OFFICE PARK DR STE A
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City | PALM COAST
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State | FL
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Zip | 32137-3808
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Country | US
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Telephone | 720-679-8486
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Fax |
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Provider Business Mailing Address
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Address Line | 5335 OXFORD CREST DR
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City | JACKSONVILLE
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State | FL
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Zip | 32258-1536
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Country | US
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Telephone | 904-588-3358
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9115662
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License Number State | FL
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