Provider Demographics
NPI:1154005304
Name:TSATOURYAN, ANI (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANI
Middle Name:
Last Name:TSATOURYAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:SAFARYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3008 ERIN WAY CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1019
Mailing Address - Country:US
Mailing Address - Phone:818-414-6553
Mailing Address - Fax:
Practice Address - Street 1:3008 ERIN WAY CT
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-1019
Practice Address - Country:US
Practice Address - Phone:818-414-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023033552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily