Provider Demographics
NPI:1194131292
Name:GORDON, TATIANA
Entity type:Individual
Prefix:MISS
First Name:TATIANA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 HYDE PARK DR.
Mailing Address - Street 2:APT. 103
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-212-3636
Mailing Address - Fax:
Practice Address - Street 1:7275 HYDE PARK DR.
Practice Address - Street 2:APT. 103
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-212-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide