Provider Demographics
NPI:1447013131
Name:GERSCOVICH, TATIANA LEAH
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:LEAH
Last Name:GERSCOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAY
Other - Middle Name:
Other - Last Name:GERSCOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9225 BAY PLAZA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4412
Mailing Address - Country:US
Mailing Address - Phone:813-814-2000
Mailing Address - Fax:
Practice Address - Street 1:9225 BAY PLAZA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4412
Practice Address - Country:US
Practice Address - Phone:813-814-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician