Provider Demographics
NPI:1912765298
Name:TATAR, EWELINA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:EWELINA
Middle Name:
Last Name:TATAR
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 S RIDGELAND AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2391
Mailing Address - Country:US
Mailing Address - Phone:708-429-3700
Mailing Address - Fax:
Practice Address - Street 1:12800 S RIDGELAND AVE STE E
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2391
Practice Address - Country:US
Practice Address - Phone:708-429-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily