Provider Demographics
NPI:1235928250
Name:HOM, TATIANA A
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:A
Last Name:HOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 VAL VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3048
Mailing Address - Country:US
Mailing Address - Phone:307-751-7331
Mailing Address - Fax:307-751-7331
Practice Address - Street 1:1245 VAL VISTA ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3048
Practice Address - Country:US
Practice Address - Phone:307-751-7331
Practice Address - Fax:307-751-7331
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management