MEDICARE: MS. TATIYANA ANISIMOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider		FL

General Provider Information

NPI Number	:	1770118259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATIYANA ANISIMOVA

Provider Business Mailing Address
First Line	:	7840 PUTNAM CIR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2739
Country	:	US
Telephone Number	:	813-598-5058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 CASA DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2235
Country	:	US
Telephone Number	:	304-550-8040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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