MEDICARE: TATYANA SEMENOVA NP

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	363LA2200X	Adult Health Nurse Practitioner	F307141	NY

General Provider Information

NPI Number	:	1891166468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATYANA SEMENOVA NP

Provider Business Mailing Address
First Line	:	2717 E 28TH ST APT 6E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2477
Country	:	US
Telephone Number	:	347-332-9186
Fax Number	:	718-975-8502

Provider Business Practice Location Address
First Line	:	2717 E 28TH ST
Second Line	:	APT 6E
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2477
Country	:	US
Telephone Number	:	347-332-9186
Fax Number	:	718-975-8502

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	07/15/2016

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