Individual
TATYANA LYTKINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORTDEFIANCE, AZ 86504
(928) 729-8132
Mailing address
PO BOX 589, FORT DEFIANCE, AZ 86504-0589
(727) 515-5743
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9101950
FL
Other
Enumeration date
07/20/2007
Last updated
11/10/2016
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