Provider Demographics
NPI:1447050596
Name:GAVRILOVIC, TANJA (DNP,APRN,CNP,PMHNPBC)
Entity type:Individual
Prefix:DR
First Name:TANJA
Middle Name:
Last Name:GAVRILOVIC
Suffix:
Gender:
Credentials:DNP,APRN,CNP,PMHNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MCDONALDS DR UNIT 611
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-5517
Mailing Address - Country:US
Mailing Address - Phone:216-526-7697
Mailing Address - Fax:
Practice Address - Street 1:2150 MCDONALDS DR UNIT 611
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-5517
Practice Address - Country:US
Practice Address - Phone:216-526-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028379363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health