Basic Information
| Provider Information | |||||||||
| NPI: | 1205297678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLIGMAN | ||||||||
| FirstName: | TATYANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14569 RUSSELL LN | ||||||||
| Address2: | |||||||||
| City: | NOVELTY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440729528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403387107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12300 MCCRACKEN RD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441252914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165810500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 02/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | COA.18889-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | COA.18889-NP | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.