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Individual

MS. TATYANA GUSTAFSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN, CNS, FPMHNP

Contact information

Practice address
5424 W HIGHWAY 290 STE 108, AUSTIN, TX 78735-8827
(512) 430-1130
(512) 677-6806
Mailing address
5424 W HIGHWAY 290 STE 108, AUSTIN, TX 78735-8827
(512) 430-1130
(512) 677-6806

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
710364
TX
364SA2200X
Adult Health Clinical Nurse Specialist
710364
TX

Other

Enumeration date
11/17/2009
Last updated
07/21/2022
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