Individual
TATIA KHARDZIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5 SQUIRE DR, LINCOLN PARK, NJ 07035-1511
(862) 591-8370
Mailing address
5 SQUIRE DR, LINCOLN PARK, NJ 07035-1511
(862) 591-8370
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NR23155600
NJ
Other
Enumeration date
12/09/2025
Last updated
12/12/2025
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